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International Society For Minimally Invasive Cardiothoracic Surgery

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Bronchoscopic Microwave Ablation Of Lung Nodules In The Hybrid Operating Room - A Novel Technique
Joyce WY Chan, Rainbow WH Lau, Calvin SH Ng.
Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR, Hong Kong, Hong Kong.

BACKGROUND: Microwave ablation of lung nodules provides a faster, larger and more predictable ablation zone than its predecessor radiofrequency energy, while bronchoscopic ablation has theoretical advantage of less pleural-based complications than percutaneous approach. The combination of bronchoscopic approach and microwave ablation is a novel approach in local treatment of lung nodules. METHODS: Forty-one lung nodules in 35 patients who underwent electromagnetic navigation bronchoscopy microwave ablation in hybrid operating room were retrospectively reviewed. Patients either refused surgery or had significantly high surgical risks. Eligible lung nodules were either proven lung cancers, metastases, or radiologically suspicious. Feasibility, safety and mid-term control rate of the technique were assessed.
RESULTS: Mean maximal diameter of lung nodules was 15.3mm (range 7-29mm), and bronchus sign was positive in only half of them. Technical success rate was 100%, although 8 nodules required double ablation for adequate coverage. Mean minimal ablation margin was 5.4mm. There was no significant heat sink effect. Mean hospital stay was 1.64 days, 31 cases (75.6%) and 39 cases (95.1%) were discharged by post-ablation day 1 and 3 respectively. Complications included mild pain which did not require hospitalization (17%), pneumothorax requiring drainage (9.8%), post-ablation reaction (4.9%), pleural effusion (2.4%) and hemoptysis (2.4%). None of the 16 nodules which completed at least 1-year post-ablative CT scan showed progressive disease. The decrease in size of ablation zone volume was most rapid in the first 6 months and reached a nadir after 9 months.
CONCLUSIONS: Bronchoscopic microwave ablation is safe and feasible, while offering a satisfactory mid-term control rate. This novel technique may represent a future local treatment modality for early stage lung cancers, lung metastases or highly suspicious lung nodules in select patients.

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