Percutaneous Lung Ablation Combined with Video-Assisted Thoracic Surgery Guided by Three-Dimensional Reconstruction in the Treatment of Multiple Pulmonary Nodules
DOI:
https://doi.org/10.30683/1927-7229.2025.14.03Keywords:
Multiple pulmonary nodules, lung microwave ablation, video-assisted thoracic surgeryAbstract
Background: With the wide application of lung cancer screening, the detection rate of multiple pulmonary nodules (MPNs) has increased annually. However, the optimal therapeutic strategy for MPNs has not achieved a consensus. This study aims to report a novel hybrid technique for the treatment of MPNs.
Methods: A total of 8 patients received CT-guided lung microwave ablation combined with video-assisted thoracic surgery from March 2020 to March 2023. Three-dimensional reconstruction was conducted to distinguish the precise localization, predict the resection extent, and conduct the optimal operation procedure for each lung nodule. The clinicopathological characteristics as well as surgical complications and short-term outcomes were recorded.
Results: 8 patients with a total of 18 nodules were treated by our hybrid technique. Two patients had a FEV1％ Pred lower than 90％. The nodules treated by surgery were confirmed as malignant by pathological results with a median size of 9mm.The median size of the nodules treated by ablation was 6mm. The median ablation power used for the nodules was 45 W (range, 40–50W). The ablation time was 5min. The median distance between nodules to pleura was 31mm (range 19-56mm). This hybrid technique did not increase the rate of complication and prolonged hospital stay. During the short term of follow-up, no recurrence occurred in the patients.
Conclusions: We present our experience of percutaneous lung ablation combined with video-assisted thoracic surgery guided by three-dimensional reconstruction in the treatment of multiple pulmonary nodules. This technique provides a minimally invasive and personalized therapy for patients with MPNs.
References
Balata H, Traverse-Healy L, Blandin-Knight S, et al. Attending community-based lung cancer screening influences smoking behaviour in deprived populations. Lung Cancer 2020; 139: 41-6. DOI: https://doi.org/10.1016/j.lungcan.2019.10.025
Kim TJ, Goo JM, Lee KW, et al. Clinical, pathological and thin-section CT features of persistent multiple ground-glass opacity nodules: comparison with solitary ground-glass opacity nodule. Lung Cancer 2009; 64(2): 171-8. DOI: https://doi.org/10.1016/j.lungcan.2008.08.002
Shimada Y, Saji H, Otani K, et al. Survival of a surgical series of lung cancer patients with synchronous multiple ground-glass opacities, and the management of their residual lesions. Lung Cancer 2015; 88(2): 174-80. DOI: https://doi.org/10.1016/j.lungcan.2015.02.016
Alzubaidi SJ, Liou H, Saini G, et al. Percutaneous Image-Guided Ablation of Lung Tumors. J Clin Med 2021; 10(24). DOI: https://doi.org/10.3390/jcm10245783
Shang Y, Li G, Zhang B, et al. Image-guided percutaneous ablation for lung malignancies. Front Oncol 2022; 12: 1020296. DOI: https://doi.org/10.3389/fonc.2022.1020296
Chamarthy MR, Gupta M, Hughes TW, et al. Image-guided percutaneous ablation of lung malignancies: A minimally invasive alternative for nonsurgical patients or unresectable tumors. J Bronchology Interv Pulmonol 2014; 21(1): 68-81. DOI: https://doi.org/10.1097/LBR.0000000000000008
Zhang M, Mao N, Zhang K, et al. Analysis of the variation pattern in left upper division veins and establishment of simplified vein models for anatomical segmentectomy. Ann Transl Med 2020; 8(22): 1515. DOI: https://doi.org/10.21037/atm-20-6925
Chen TF, Xie CY, Rao BY, et al. Surgical treatment to multiple primary lung cancer patients: a systematic review and meta-analysis. BMC Surg 2019; 19(1): 185. DOI: https://doi.org/10.1186/s12893-019-0643-0
Altorki N, Wang X, Kozono D, et al. Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. N Engl J Med 2023; 388(6): 489-98. DOI: https://doi.org/10.1056/NEJMoa2212083
Yang H, Xiao X, Mei T, et al. Long-term survival analysis of sublobar resection versus lobectomy for older patients with early-stage pulmonary carcinoid tumour: a database-based propensity score-matched study. Aging Clin Exp Res 2022; 34(8): 1925-34. DOI: https://doi.org/10.1007/s40520-022-02112-0
Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet 2022; 399(10335): 1607-17. DOI: https://doi.org/10.1016/S0140-6736(21)02333-3
Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology 2013; 266(1): 304-17. DOI: https://doi.org/10.1148/radiol.12120628
Wang XH, Liu XF, Ao M, et al. Cerebral Perfusion Patterns of Anxiety State in Patients With Pulmonary Nodules: A Study of Cerebral Blood Flow Based on Arterial Spin Labeling. Front Neurosci 2022; 16: 912665. DOI: https://doi.org/10.3389/fnins.2022.912665
Qiu H, Lou Y, Wang Z, Xue F, Chen Z, Xu C, et al. Factors influencing surgical choice and anxiety in patients with pulmonary nodules smaller than 8 mm. Journal of Thoracic Disease 2023; 15(12): 6889-97. DOI: https://doi.org/10.21037/jtd-23-1701
Maxwell CM, Ng C, Fernando HC. Stereotactic Body Radiation Therapy Versus Ablation Versus Surgery for Early-Stage Lung Cancer in High-Risk Patients. Thorac Surg Clin 2023; 33(2): 179-87. DOI: https://doi.org/10.1016/j.thorsurg.2023.01.003
Huang BY, Li XM, Song XY, et al. Long-term results of CT-guided percutaneous radiofrequency ablation of inoperable patients with stage Ia non-small cell lung cancer: A retrospective cohort study. Int J Surg 2018; 53: 143-50. DOI: https://doi.org/10.1016/j.ijsu.2018.03.034
Han X, Wei Z, Zhao Z, et al. Cost and effectiveness of microwave ablation versus video-assisted thoracoscopic surgical resection for ground-glass nodule lung adenocarcinoma. Front Oncol 2022; 12: 962630. DOI: https://doi.org/10.3389/fonc.2022.962630
Harrison OJ, Sarvananthan S, Tamburrini A, et al. Image-guided combined ablation and resection in thoracic surgery for the treatment of multiple pulmonary metastases: A preliminary case series. JTCVS Tech 2021; 9: 156-62. DOI: https://doi.org/10.1016/j.xjtc.2021.03.013
Qu R, Tu D, Hu S, et al. Electromagnetic Navigation Bronchoscopy-Guided Microwave Ablation Combined With Uniportal Video-Assisted Thoracoscopic Surgery for Multiple Ground Glass Opacities. Ann Thorac Surg 2022; 113(4): 1307-15. DOI: https://doi.org/10.1016/j.athoracsur.2021.04.061
Wang X, Wang Q, Zhang X, et al. Application of three-dimensional (3D) reconstruction in the treatment of video-assisted thoracoscopic complex segmentectomy of the lower lung lobe: A retrospective study. Front Surg 2022; 9: 968199. DOI: https://doi.org/10.3389/fsurg.2022.968199
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.