Neodymium:yttrium-aluminum-garnet laser for the treatment of tracheobronchial recurrences in esophageal carcinomas.

Tracheobronchial recurrence occurred in 55 of 559 patients (9.8%) after resection of their esophageal carcinomas and in 22 of 109 patients (20.2%) after a bypass operation. The risk of airway recurrence increases if residual disease is present in the mediastinum at resection. The median survival of 55 patients diagnosed with tracheobronchial recurrence before July 1988 was 3.7 weeks. After July 1988, there were 22 patients in whom tracheobronchial recurrence developed, 19 of whom were treated by neodymium:yttrium-aluminum-garnet laser under local anesthesia. Additional external radiotherapy was offered to 8 patients who responded to laser treatment and were in satisfactory condition. Four of these patients (21%) had complete tumor regression. Partial regression occurred in 7 patients (37%): 2 were treated by combined therapy and 5 by laser alone. Most tolerated the laser treatment well, but the procedure was abandoned in 6 patients because of smoke inhalation. A tracheoesophageal fistula developed in 2 patients. The median survival for the entire group was 7.4 weeks, with 3 long survivors who lived more than 1 year. The combined application of laser and external radiotherapy is effective for the treatment of tracheobronchial recurrences in patients with esophageal carcinoma.