Aydın YILMAZ, Zafer AKTAŞ, Ayperi ÖZTÜRK, Mevlüt KARATAŞ

Endobronşiyal hamartomların endoskopik tedavisinde nüksleri önleyebilir miyiz?

Giriş: Endobronşiyal hamartomların girişimsel bronkoskopik yöntemlerle tedavisi mümkündür. Tedavi edici etkinlikleri ile ilgili birkaç bildiri olmasına rağmen uygulama protokolü merkezler arasında değişmekte ve yüksek nüks oranları problem olmaya devam etmektedir. Bu çalışmada, girişimsel bronkoskopik yöntemlerle endobronşiyal hamartomun intraluminal kısmının çıkarılmasından sonra bronş duvarındaki lezyon köküne uygulanan kriyoterapinin nüksleri önleyebileceğini göstermeyi amaçladık. Materyal ve Metod: 2012-2016 yılları arasında semptomatik endobronşiyal hamartomu olan ve girişimsel bronkoskopik yöntemlerle tedavi ettiğimiz ardışık 21 hastanın tedavi sonuçları ve uzun dönem takipleri prospektif olarak kayıt edildi. Veriler retrospektif olarak incelendi. Bulgular: Hastaların 20 (%95.2)’sinde tam rezeksiyon, yalnızca 1 (%4.8)’inde inkomplet rezeksiyon yapıldı. Debulking sonrası tüm lezyonların bronş duvarında izlenen kök kısımlarına kriyoterapi yapıldı. İnkomplet rezeksiyon yapılan 1 (%4.8) hasta takibinin 20. ayında nüks etti ve sağ alt lobektomi ile tedavi edildi. Diğer 20 (%95.2) hasta periyodik toraks bilgisayarlı tomografi ve bronkoskopilerle ortalama 36.0 ± 15.0 ay takip edildi. Nüks saptanmadı. İşlemlere bağlı komplikasyon veya ölüm izlenmedi. Sonuç: Endobronşiyal hamartomların bronkoskopik yöntemlerle debulkingi etkili ve güvenli tedavi yöntemidir. Lezyon köküne yapılan kriyoterapi, yüksek nüks oranlarını önleyebilir.

Can we prevent recurrences in the endoscopic treatment of endobronchial hamartomas?

Introduction: Recently, treatment of endobronchial hamartomas with interventional bronchoscopic methods has become possible.Although there are several reports of therapeutic benefits, the protocol of administration varies between centers and high recurrencerates continue to be a problem. In this study, we aimed to show that cryotherapy applied to the root of the bronchial wall afterremoval of the intraluminal portion of endobronchial hamartoma with interventional bronchoscopic methods can prevent recurrences.Materials and Methods: Between 2012-2016, the treatment outcomes and long-term follow-up data of patients with symptomaticendobronchial hamartomas treated by interventional bronchoscopic methods were prospectively recorded. After debulking,cryotherapy was applied to the root of the bronchial wall of all lesions. The data were analyzed retrospectively.Results: A total of 21 consecutive patients were studied. Twenty (95.2%) of the patients underwent complete resection and only 1(4.8%) had incomplete resection with various interventional bronchoscopy techniques. One (4.8%) patient who underwentincomplete resection and ineffective cryotherapy relapsed. The other 20 (95.2%) patients were followed up periodically for anaverage of 36.0 ± 15.0 months. No recurrence was detected. No complications or deaths related to the procedure were observed.Conclusion: Debulking of endobronchial hamartomas with interventional bronchoscopic methods is effective and safe. Cryotherapyto the root of the lesion may prevent high recurrence rates.

PDF

___

Murray J, Kielkowski D, Leiman G. The prevalence and age distribution of peripheral pulmonary hamartoma in adult males: an autopsy-based study. S Afr Med J 1991;79:247-9.
David HB, Samuel PH. Pulmonary pathology; 2nd ed. Springer, New York 1994.
Gjevre JA, Myers JL, Prakash UB. Pulmonary hamartomas. Mayo Clin Proc 1996:71:14-20.
Cosio BG, Villena V, Echave-Sustaeta J, de Miquel E, Alfaro J, Hernandez L, et al. Endobronchial hamartoma. Chest 2002;122:202-5.
Kim SA, Um SW, Song JU, Jeon K, Koh WJ, Suh GY, et al. Bronchoscopic features and bronchoscopic intervention for endobronchial hamartoma. Respirology 2010;15:150-4.
Jhun BW, Lee K, Jeon K, Um SW, Suh GY, Chung MP, et al. The clinical, radiological and bronchoscopic findings and outcomes in patients with benign tracheobronchial tumors. Yonsei Med J 2014;55:84-91.
Wang J, Huang M, Zha W, Zhou L, Qi X, Wang H. Flexible bronchoscopic intervention for endobronchial hamartoma. Chinese J Tuberc Respir Dis 2013;36:963-7.
Miller SM, Bellinger CR, Chatterjee A. Argon plasma coagulation and electrosurgery. J Broncho Interv Pulmonol 2013;20:38-40.
Shah H, Garbe L, Nussbaum E, Dumon JF, Chiodera PL, Cavaliere S. Benign tumors of the tracheobronchial tree. Endoscopic characteristics and role of laser resection. Chest 1995;107:1744-51.
Abdel Hady SM, Elbastawisy SE, Hassaballa AS, Elsayed HH. Is surgical resection superior to bronchoscopic resection in patients with symptomatic endobronchial hamartoma? Interact Cardiovasc Thorac Surg 2017;24:778-82.
Vergnon JM. How I do it: bronchoscopic cryotherapy. J Bronchol 1995;2:323-7.
Mazur P. The freezing of biological systems. Science 1970;168:939-49.
Neel HG, Farrell KH, Payne WS. Cryosurgery of respiratory structures 1-cryonecrosis of trachea and bronchus. Laryngoscope 1973;83:1062-71.
Vergnon JM. Cryothe´rapie endobronchique: techniques et indications. [Endobronchial cryotherapy: techniques and indications]. Rev Mal Respir 1999;16:619-23.
Homasson JP. Bronchoscopic cryotherapy. Journal Bronchol 1995;2:145-53.
Vergnon JM, Guichenez Ph, Fournel P, Emonot A. Efficiency of cryotherapy in bronchial tumors. Am Rev Respir Dis 1990;141:A402.
Vergnon JM, Huber RM, Moghissi K. Place of cryotherapy, brachytherapy and photodynamic therapy in therapeutic bronchoscopy of lung cancers. Eur Respir J 2006;28:200- 18.
Homasson JP, Renault P, Angebault M, Bonniot JP, Bell NJ. Bronchoscopic cryotherapy for airway strictures caused by tumors. Chest 1986;90:159-64.
Bertoletti L, Elleuch R, Kaczmarek D, Jean-François R, Vergnon JM. Bronchoscopic cryotherapy treatment of isolated endoluminal typical carcinoid tumor. Chest 2006;130:1405-11.
Deygas N, Froudarakis M, Ozenne G, Vergnon JM. Cryotherapy in early superficial bronchogenic carcinoma. Chest 2001;120:26-31.