Application of lasers in thoracic surgery: a retrospective cohort study

Background: Laser technology is increasingly used in thoracic surgery for airway lesions and pulmonary metastases, but regional outcome data are limited. This study assessed perioperative results of laser application at a tertiary university hospital. Methods: A retrospective cohort study included all patients undergoing laser therapy for airway lesions or pulmonary metastases between January 2005 and December 2021. CO 2 and Nd:YAG lasers were used endoscopically for airway lesions and via open thoracotomy for metastasectomy. Data were analyzed using χ 2 testing, with Kaplan–Meier survival analysis; P < 0.05 was considered significant. Results: Eighty-eight patients were included: 65 with airway lesions (50.8% scarring, 49.2% tumorous) and 23 with pulmonary metastases. In the airway group, early complications occurred in four patients (6.2%) with one postoperative death; older age was associated with both early complications ( P = 0.04) and the need for subsequent surgery ( P = 0.009, φ = 0.35), though age and lesion malignancy were confounded. In the metastasectomy group, all resections were complete (R0), and 1-year survival was 80.9% (21 evaluable patients); bilateral disease ( P = 0.002, φ = 0.69) and a shorter disease-free interval ( P = 0.03) were associated with reduced survival. Conclusions: Laser-assisted thoracic surgery is a safe and effective modality for airway and pulmonary lesion management. Older age in the airway group, and bilateral disease and shorter disease-free interval in the metastasectomy group, identify higher-risk patients. These hypothesis-generating associations should inform patient selection and counseling, particularly in centers with limited access to conventional alternatives.