BACKGROUND:
Multifocal lung cancers and lung oligometastases are increasingly prevalent. Transbronchial microwave ablation using electromagnetic navigation bronchoscopy (ENB) is an emerging local therapy for lung preservation. When performed with lung resection, lesions at different locations could be managed in one-stop as part of multi-modality personalized treatment.METHODS:
Out of 150 patients who underwent ENB microwave ablation in hybrid operating room from April 2019 to September 2023, 11 patients had concomitant video-assisted thoracoscopic surgery (VATS) in the same operating session. Nodules included primary and secondary cancers. Feasibility and safety of the technique was retrospectively reviewed.
RESULTS:
The 11 cases of concomitant ablation and lung resection (wedge resection, segmentectomy or lobectomy) consisted of 6 males, with a mean age of 58. Reasons for local therapy were multifocal lung cancer (54.5%) and oligometastases (45.5%). Of the 6 patients with multifocal disease, 2 had previous lobectomies and 3 had planned major lung resection of the remaining nodules. A mean of 2.73 nodules were treated in the current episode, ranging from 2 to 6. Eight out of 11 had lung resection on the ablation side, where ablated pleura with whitish greyish discoloration can be observed in 4 patients. In 3 cases, ENB dye marking was performed to aid subsequent VATS wedge resection. Two patients had two nodules ablated in the same session followed by VATS. The mean nodule size of ablated nodules was 9mm (range 5-19mm), while 9 nodules (82%) required multiple ablation to achieve a mean minimal margin of 6.45mm. Patients undergoing concomitant ablation and resection benefit from shorter total operative time at a mean of 243 minutes (mean ENB ablation +/- dye marking duration was 156 minutes while mean VATS duration was 87.4 minutes), compared to 301 minutes in 31 patients who had separate surgery and ablation during the same period (p<0.05). Mean hospital stay was 2.82 days, all patients were discharged by day 3, except for 1 patient who developed bronchopleural fistula from ENB ablation and required endobronchial valve placement. There were no other complications.
CONCLUSIONS:
Deeper nodules are better treated with ablation while peripheral lesions can be easily resected. Concomitant transbronchial ablation, dye-marking and surgery is feasible and safe. This is an important component of multi-modality lung preserving strategy for battling multiple lung malignancies.
