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MANAGEMENT OF CENTRAL AIRWAY OBSTRUCTION BY CRYO SURGERY AND

ARGON PLASMA COAGULATION

ACHMAD MULAWARMAN JAYUSMANBandung , 06 February 2016

Dr. A Mulawarman J, SpP(K), Dr. Eddy Soeratman SpP(K), Dr. Arif R Hanafi, SpP, Dr. Evlina Suzanna, SpPA,, Dr. Tagor Oliver Tambunan SpBT, DR.Dr. Dody Ranuhadi Sp.PD KHOM, DR. Dr. Noorwati S, SpPD KHOM, Dr. Asrul Harsal SpPD KHOM, Dr. Bangun Astarto SpRad(K) Onk Rad, Dr.DewiSoeis SpRad(K) Onk Rad, Dr. Kardinah SpRad, Dr. Sri Hartini SpPK MARS, Dr. Hera Pratiwi SpRM, Dr. Maria Witjaksono MPhal,Dr. Sariningsih SpRad,Dr. Rosalina SpRad, Dr .Maria R Yunti SpPA. Pradnya SKM, Tiarlan SKM, Fariha SKM, Siti Zahara SKM.

TIM KERJA PARURS KANKER DHARMAIS

THERAPEUTIC APPROACHES

Dilation of the airways ( Bronchoplasty )

Electrocautery

Argon Plasma Coagulation

Laser Therapy

Photodynamic Therapy

Cryotherapy

External Beam Radiation & Brachytherapy

Airway Stents Placement

Surgical Resection

TRANSTHORACAL CRYOSURGERY

ANATOMY OF MAJOR BLOOD VESSELS

BENEFITS

Cryobiopsy• Endobronchial & Transbronchial

• High diagnostic quality

Cryorecanalization

• Exophytic stenoses with immediate effect

• Frontal or tangential approach

Cryodevitalization

• For Ablation tumor ingrowths & overgrowths

CRYOSURGERY IN CENTRAL AIRWAY OBSTRUCTION

CRYO VS LASER

CRYO SURGERY

• Flexible bronchoscope

• Easier

• Freezing

• Minimal haemorage

• Non smoke

• Short time

• More safety

• Cheaper

LASER

• Rigid bronchoscope

• Difficult

• Burning

• High risk

• Smoke

• Longer

• High risk perforation

• More expensive

MULTIDISCIPLINARY TEAM APPROACH

• CHEST RADIOLOGIST

• ANESTHESIOLOGISTS

• INTERVENTIONAL PULMONOLOGISTS

• MEDICAL REHABILITATION

• INTENSIVISTS

• PATHOLOGIST

• BRONCHOSCOPY STAFFS

MULTIDISCIPLIN OF APLICATION FOR THE CRYO

• PNEUMOLOGY : Bronchial stenosis, recanalization,biopsies

• PHLEBOLOGY : Varicous vein of the lower limbs

• THORACIC SURGERY : Post operative cryo analgesia

• GYNECOLOGY : Cervical ectopias and condylomas

• PROCTOLOGY : Inner hemorrhoids of the first and second degree, acut anal fissures

• ENT : Hemangiomas, papillomas, etc

• DERMATOLOGY: Warts, condylomas, etc

INDICATION (1)

Malignant• Primary endolumenal carcinoma

• Metastatic carcinoma to the airway

• Laryngeal carcinoma

• Esophageal carcinoma

• Mediastinal tumors

• Lymphadenopathy associated with malignancy

INDICATION (2)

Non malignant• Limphadenopathy

• Granulation tissue

• Pseudotumor

• Tracheo /bronchomalacia

• Others : Mucus plug

Blood clot

CONTRA INDICATION

• EXTRINSIC COMPRESSION

• A THROMBOCYTE COUNT OF LESS THAN

100 G/L

• ABNORMAL PLASMA CLOTTING

ARGON PLASMA COAGULATION

• A non contact form of electrocoagulation

• Effective for the treatment of endoluminal hemoptysis and airway obstruction

• The procedure can be perform in an outpatient setting or at the bedside in the ICU’s

• Type of APC probe : direct, lateral & circle.

DATA RECORD OF CRYO SURGERY AND APCDHARMAIS HOSPITAL

N %

Male 29 83

Female 6 17

Total 35 100

Carcinoma N %

Lung cancer 15 42.9

Laringeal cancer 10 28.6

Thyroid cancer 5 14.3

Colon cancer 2 5.7

Testis cancer 1 2.8

Vocal cord cancer 1 2.8

Tracheal cancer 1 2.8

Total 35 100

Case 1

• NAME : Mr R

• AGE : 32 yo

• THE MAIN COMPLAINT

- Short breathness

• DIAGNOSIS

- Adenocarsinoma of the left lung

• DURATION

- 75 Minutes

CRYO SURGERY

Pre cryo surgery Post cryo surgery

Case 2

• NAME : Mr E

• AGE : 75 yo

• THE MAIN COMPLAINT

- Short breathness

• DIAGNOSIS

- Colon carcinoma metastasis to the left lung

• DURATION

- 120 minutes

CHEST X-RAY

VIRTUAL BRONCHOSCOPY CT SCAN

FUNGAL INFECTION

EXTERNAL BEAM RADIATION

IMPACT OF THERAPY

• BETTER QUALITY OF LIFE• SURVIVAL IS IMPRESSIVE

• SO, THE AVAILABLE PRIMARY QUESTION WILL NOT BE ..

- Is therapy helpful ? But...............

- Which therapy is best for a particular patient ?

SUMMARY

• Virtual Bronchoscopy CT scan is needed as preparation for cryosurgery

• For the treatment of Central Air (CAO) by cryo surgery, to be followed Argon Plasma Coagulation (APC) and other lung cancer therapy

• Post cryo surgery is required antifungal therapy

CRYO SURGERY TEAM - RSKD

Thank youLembah Baliem, Agustus 2015

PERTANYAAN 1

Therapy cryo surgery pada obstruksi jalannapas utama, dapat dilakukan pada :

1. Penekanan dari luar (eksternal)

2.Lesi infiltratif dibawah pita suara dapatlangsung dilakukan tindakan cryo surgery

3.Lesi infiltratif yang berasal dari thyroid, trakea dan paru, dapat dilakukan cryo surgery

PERTANYAAN 2

Pasca menjalani cryo surgery, untuk rekanalisasiobstruksi jalan napas utama :

1. Cukup hanya cryo surgery saja

2. Harus dikombinasi dengan terapi kankerparu lainnya

3. Tidak perlu pengobatan anti jamur