Other Advanced Procedures

Large airway tumour debulking
Metallic stent placement for airway narrowing and fistulas
Tracheal dilatation
Rigid bronchoscopy

These are procedures that require advanced expertise and skill level. Only a handful of interventional
bronchoscopists can perform these procedures safely with satisfactory outcomes.
The procedures are summarised here and if you require this type of advanced procedure Dr Herath will discuss with you the risks and benefits on individual basis.

Large airway tumour removal

What is large airway obstruction?

Large airways are your large windpipes which includes trachea and main right and left bronchus.
In some patients with lung cancer and patients with other cancers that have spread to lungs like breast, melanoma, colon and prostate, the cancer can grow in the windpipe making it narrow or it can grow outside making the windpipes narrower.

What conditions is tumour removal and stent used for?

Patients commonly present with shortness of breath, lung collapse or coughing up blood.
This is usually a life-threatening complication of advanced cancer and patients are usually placed in an urgent operating list.
The procedure will be performed in the operating theatre at Westmead Public Hospital or Macquarie University Hospital or Chris O Brien Lifehouse.

What are the side effects of a tumour removal and stent placement?

This is a complicated procedure and only a very few interventional bronchoscopists are fully trained in this procedure.
The side effects are multiple and life-threatening.
This procedure will be performed only if not doing the procedure would be terminal or the quality of life without the procedure leaves the patient palliative.

Common side effects during or immediately after the procedure	What to Do
Bleeding during procedure	We are prepared for a bleed especially during removal of tumour. There is always a risk of a life-threatening bleed during this procedure.
Air leak outside the lung	If we anticipate an air leak, we will perform an USS or a Chest X ray to find out if this had occurred. There is a risk of delayed pneumothorax occurring while you are in ICU or HDU.
Infection post procedure	Infections can occur when collapsed lungs re expand after the procedure. You will need resuscitation and antibiotics.
Stent migration	This occurs if your tumour shrinks with treatment. If this happens the stents will need to be taken out
Stent obstruction by sputum	You must use nebulised saline twice daily for the duration of the stent placement If stents are not kept moist, they aciculate sputum that gets dried and obstruct the stent causing SOB
Radiotherapy requirement	Stents are placed to prevent life-threatening obstruction. You will need RT for more sustained effect long term. This is usually started whilst in hospital

When can you return to work?

You can return to work and start all your normal medications including blood thinners the next day.