Endoscopic treatment of primary benign central airway tumors: Results from a large consecutive case series and decision making flow chart to address bronchoscopic excision.
BACKGROUND
Benign tracheo-bronchial neoplasms are rare, but potentially dangerous conditions with life threatening consequences. Tumor removal should be pursued by methods minimizing the procedural stress. The role of endoscopic treatment, as an alternative to open surgery, remains controversial.


OBJECTIVE
report the twelve-years endoscopic experience in Rome, Italy. Fifty-seven benign tracheo-bronchial tumors were diagnosed and 130 tracheo-bronchial resections by rigid bronchoscopy performed.


METHODS
we identified histotypes associated with higher recurrence rate and assessed their relationship with gender, age and tracheo-bronchial location. We provided data on safety and complications and suggested a decision making flow chart to address the patients to endoscopic resection.


RESULTS
complete eradication after a single procedure without recurrence at 2 years was obtained in 63.1% of cases (36/57). Need of a second intervention within few months but no further recurrence at follow up was seen in a further 8.8% (5/57). Histotypes associated with recurrence were papillomas and inflammatory polyp. Seven patients (12.3%) were addressed to surgery because of multiple recurrence. Ten patients (17.5%) were lost at follow up. In case of recurrence, the bronchial biopsy was always repeated and no malignant transformation was observed. No major complications, pneumothorax or pneumomediastinum occurred.


CONCLUSIONS
endoscopic treatment of benign tracheo bronchial tumors is safe and effective, provided that the procedure is carefully and systematically planned. The rate of eradication is satisfactory and the incidence of complications negligible. This will encourage this approach as first line treatment especially in patients, frequently elderly people, having increased surgical risk due to concomitant respiratory failure or major comorbidities.
Geriatrics, Unit of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio Medico University and Teaching Hospital, Rome, Italy. Electronic address: s.scarlata@unicampus.it.
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Scarlata
Pathology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.
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Graziano
Unit of Thoracic Endoscopy, San-Camillo Forlanini Hospital, Rome, Italy.
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Lucantoni
Unit of Thoracic Endoscopy, San-Camillo Forlanini Hospital, Rome, Italy.
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Battistoni
Unit of Thoracic Endoscopy, San-Camillo Forlanini Hospital, Rome, Italy.
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Batzella
Unit of Thoracic Endoscopy, San-Camillo Forlanini Hospital, Rome, Italy.
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Dello Jacono
Geriatrics, Unit of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio Medico University and Teaching Hospital, Rome, Italy.
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Antonelli Incalzi
Unit of Thoracic Endoscopy, San-Camillo Forlanini Hospital, Rome, Italy.
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Galluccio
D000368:Aged; D001984:Bronchial Neoplasms / Q000473:pathology / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods*; D000066491:Clinical Decision-Making; D015331:Cohort Studies; D005260:Female; D006222:Hamartoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010212:Papilloma / Q000473:pathology / Q000601:surgery*; D011127:Polyps / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D014134:Tracheal Neoplasms / Q000473:pathology / Q000601:surgery*
Benign tracheo-bronchial tumors; Bronchoscopy; Case series; Endoscopic treatment