ENDOLUMINAL SURGERY Cryorecanalization: keys to success AydınYılmaz • Zafer Aktas ¸ • I ˙ brahim Onur Alici • Atalay C ¸ ag ˘lar • Hilal Sazak • Fatma Ulus Received: 28 June 2011 / Accepted: 16 March 2012 Ó Springer Science+Business Media, LLC 2012 Abstract Background Symptomatic airway obstructions are com- mon with endobronchial exophytic tumors and may result in lethal complications. Recently, a cryorecanalization procedure has emerged that plays a role in the immediate management of airway obstruction. This study was con- ducted to investigate the value of cryorecanalization for the immediate management of endobronchial obstructive pathology and to determine the factors that affect the success of the procedure. Methods We analyzed 40 patients with symptoms of airway obstruction who were admitted to our hospital from 2006 to 2010. Patients with exophytic stenosis due to pri- mary bronchial or metastatic neoplasms who underwent cryorecanalization procedures were included. Patients were excluded if they had involvement of a major artery near the site of the intervention. The procedure was not performed on patients with coagulation abnormalities or thrombocyte count and aggregation problems. The data were collected retrospectively. Results Successful cryorecanalization was achieved in 72.5 % of patients. We found that the success rate was mainly related to the presence of the distal involvement and the older age of obstruction. Restenosis rate was 12.8 %. The mean survival time after the cryorecanaliza- tion procedure was 11 ± 12.7 months. No complications occurred in 14 patients. No severe bleeding was observed for any patients, and moderate hemorrhaging occurred in ten patients, which was stopped with an argon plasma coagulator. We experienced no intraoperative mortality. Conclusions Cryorecanalization is a successful and safe intervention for the immediate management of endobron- chial stenosis. Appropriate patient selection and high suc- cess rates should be achieved after careful radiological assessments and with early management. Keywords Cryorecanalization Á Lung cancer Á Airway obstruction Á Interventional bronchoscopy Airway obstruction is commonly observed with endo- bronchial exophytic tumors. Up to 30 % of lung cancers cause obstructions at the level of the trachea and main bronchi [1]. The most common manifestations of these obstructions are dyspnea, cough, and hemoptysis [2], and they may result in lethal complications, such as respiratory failure, atelectasis, and postobstructive pneumonia. With regard to treatment, many interventional bronchoscopists prefer laser, electrocautery, argon plasma coagulation, mechanical recanalization, and stents because of their immediate effects [3]. Endobronchial cryotherapy is used to treat malignant airway tumors, but conventional usage is limited to the palliation of noncritical endobronchial exophytic lesions and early lung cancers and for the removal of foreign bodies and clots [4]. In addition, 8–10 days are required for a complete therapeutic effect [5]. Clean-up bronchoscopy is usually performed. Recently, a new technique, cryore- canalization, has emerged for immediate debulking of exophytic endobronchial tumors [2, 6, 7]. In this technique, a bronchoscopist retracts frozen tissue at the tip of the probe with a bronchoscope, resulting in immediate tumor A. Yılmaz Á Z. Aktas ¸ Á I ˙ . O. Alici (&) Á H. Sazak Á F. Ulus Atatu ¨rk Chest Diseases and Thoracic Surgery Education and Research Hospital, 06280 Ankara, Turkey e-mail: ioalici@hotmail.com A. C ¸ ag ˘lar Department of Econometrics, Pamukkale University, Denizli, Turkey 123 Surg Endosc DOI 10.1007/s00464-012-2260-1 and Other Interventional Techniques