Rigid bronchoscopic intervention for airway stenosis in post-pneumonectomy patients

Airway stenosis in post-pneumonectomy patients is a life-threatening condition that requires urgent intervention. While rigid bronchoscopy has been used for treatment, its clinical utility and safety have been documented only in a limited number of case reports. This study evaluated the efficacy and safety of rigid bronchoscopic intervention for airway stenosis in post-pneumonectomy patients. We retrospectively reviewed the medical records of all post-pneumonectomy patients with airway stenosis who underwent rigid bronchoscopic intervention at NHO Nagoya Medical Center between June 2012 and June 2022. All procedures were performed using both rigid and flexible bronchoscopes under general anesthesia in the operating room. During the study period, 793 patients underwent rigid bronchoscopy, of whom 9 post-pneumonectomy patients (undergoing a total of 21 procedures) were included in the analysis. All cases of airway stenosis were associated with recurrent malignant disease. All nine patients presented with respiratory symptoms and five required supplemental oxygen, with three necessitating mechanical ventilation before the initial procedure. All symptomatic patients experienced improvement and were discharged without the need for supplemental oxygen. Two patients required frequent rigid bronchoscopic interventions (one six and one eight times), including tumor or granuloma resection and stent placement. No procedure-related mortality occurred. The median survival was 141 days (range: 24–1,039 days). Rigid bronchoscopic intervention effectively alleviates respiratory symptoms in post-pneumonectomy patients with airway stenosis. However, given the high incidence of complications, the procedure should be performed by experienced operators in specialized centers.