Efficacy of Therapeutic Bronchoscopic Interventions in Patients with Unilateral Total Lung Atelectasis Secondary to Lung Cancer.

PURPOSE Malignant central airway obstruction (MCAO) secondary to lung cancer can result in unilateral total lung atelectasis, a life-threatening condition with limited data on survival outcomes and the role of therapeutic bronchoscopy. This study aimed to evaluate survival and prognostic factors in lung cancer patients with MCAO-induced total lung atelectasis and to assess the impact of bronchoscopic interventions.

METHODS We retrospectively analyzed 123 lung cancer patients with MCAO and unilateral total lung atelectasis treated at a single center. Of these, 84 underwent therapeutic bronchoscopic intervention, while 39 did not. Short-term survival (90-day mortality and median survival) was compared. Multivariate Cox regression was used to identify independent predictors of mortality.

RESULTS Overall, 60.2% of patients died within 90 days. Bronchoscopic intervention was associated with lower 90-day mortality (52% vs 77%, p=0.01) and longer median survival (88 vs 37 days, p<0.001). Independent predictors of higher 90-day mortality included ECOG performance status 3-4, small cell lung cancer histology, stage IV disease, pulmonary artery (PA) invasion, extended lesions, and failure to restore airway patency. Among patients with PA invasion, recanalization did not improve survival (p=0.34).

CONCLUSIONS MCAO-induced total lung atelectasis in lung cancer patients is associated with poor short-term survival. Therapeutic bronchoscopy improves survival in selected patients, but its benefit is limited in the presence of PA invasion. Careful patient selection is critical when planning bronchoscopic intervention.