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Sebek J, Kramer S, Rocha R, Yu KC, Bortel R, Beard WL, Biller DS, Hodgson DS, Ganta CK, Wibowo H, Yee J, Myers R, Lam S, Prakash P. Bronchoscopically delivered microwave ablation in an in vivo porcine lung model. ERJ Open Res 2020; 6:00146-2020. [PMID: 33083442 PMCID: PMC7553114 DOI: 10.1183/23120541.00146-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
Background Percutaneous microwave ablation is clinically used for inoperable lung tumour treatment. Delivery of microwave ablation applicators to tumour sites within lung parenchyma under virtual bronchoscopy guidance may enable ablation with reduced risk of pneumothorax, providing a minimally invasive treatment of early-stage tumours, which are increasingly detected with computed tomography (CT) screening. The objective of this study was to integrate a custom microwave ablation platform, incorporating a flexible applicator, with a clinically established virtual bronchoscopy guidance system, and to assess technical feasibility for safely creating localised thermal ablations in porcine lungs in vivo. Methods Pre-ablation CTs of normal pigs were acquired to create a virtual model of the lungs, including airways and significant blood vessels. Virtual bronchoscopy-guided microwave ablation procedures were performed with 24–32 W power (at the applicator distal tip) delivered for 5–10 mins. A total of eight ablations were performed in three pigs. Post-treatment CT images were acquired to assess the extent of damage and ablation zones were further evaluated with viability stains and histopathologic analysis. Results The flexible microwave applicators were delivered to ablation sites within lung parenchyma 5–24 mm from the airway wall via a tunnel created under virtual bronchoscopy guidance. No pneumothorax or significant airway bleeding was observed. The ablation short axis observed on gross pathology ranged 16.5–23.5 mm and 14–26 mm on CT imaging. Conclusion We have demonstrated the technical feasibility for safely delivering microwave ablation in the lung parenchyma under virtual bronchoscopic guidance in an in vivo porcine lung model. This paper demonstrates the technical feasibility of safely delivering microwave ablation in the lung parenchyma under virtual bronchoscopic guidance in an in vivo porcine lung modelhttps://bit.ly/32aruLf
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Affiliation(s)
- Jan Sebek
- Dept of Electrical and Computer Engineering, Kansas State University Manhattan, Manhattan, KS, USA.,Dept of Circuit Theory, Czech Technical University in Prague, Prague, Czech Republic
| | | | - Rob Rocha
- Broncus Medical, Inc., San Jose, CA, USA
| | | | - Radoslav Bortel
- Dept of Circuit Theory, Czech Technical University in Prague, Prague, Czech Republic
| | - Warren L Beard
- Dept of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - David S Biller
- Dept of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - David S Hodgson
- Dept of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - Charan K Ganta
- Dept of Diagnostic Medicine/Pathobiology, Kansas State University, Manhattan, KS, USA
| | | | - John Yee
- Dept of Thoracic Surgery, Vancouver General Hospital and the University of British Columbia, Vancouver, Canada
| | - Renelle Myers
- Dept of Thoracic Surgery, Vancouver General Hospital and the University of British Columbia, Vancouver, Canada.,Dept of Integrative Oncology, BC Cancer Research Center and the University of British Columbia, Vancouver, Canada
| | - Stephen Lam
- Dept of Integrative Oncology, BC Cancer Research Center and the University of British Columbia, Vancouver, Canada
| | - Punit Prakash
- Dept of Electrical and Computer Engineering, Kansas State University Manhattan, Manhattan, KS, USA
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Nelson DB, Tam AL, Mitchell KG, Rice DC, Mehran RJ, Sepesi B, Antonoff MB, Vaporciyan AA, Hofstetter WL. Local Recurrence After Microwave Ablation of Lung Malignancies: A Systematic Review. Ann Thorac Surg 2019; 107:1876-1883. [DOI: 10.1016/j.athoracsur.2018.10.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/10/2018] [Accepted: 10/16/2018] [Indexed: 11/25/2022]
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叶 欣, 范 卫, 王 徽, 王 俊, 古 善, 冯 威, 庄 一, 刘 宝, 李 晓, 李 玉, 杨 坡, 杨 霞, 杨 武, 陈 俊, 张 嵘, 林 征, 孟 志, 胡 凯, 柳 晨, 彭 忠, 韩 玥, 靳 勇, 雷 光, 翟 博, 黄 广, 中国抗癌协会肿瘤微创治疗专业委员会肺癌微创治疗分会. [Expert Consensus for Thermal Ablation of Primary and Metastatic Lung Tumors
(2017 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:433-445. [PMID: 28738958 PMCID: PMC5972946 DOI: 10.3779/j.issn.1009-3419.2017.07.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- 欣 叶
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - 卫君 范
- 510060 广州, 中山大学肿瘤医院影像与微创介入中心Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - 徽 王
- 130012 长春, 吉林省肿瘤医院介入治疗中心Interventional Treatment Center, Jilin Provincial Tumor Hospital, Changchun 130012, China
| | - 俊杰 王
- 100191 北京, 北京大学第三医院放射治疗科Department of Radiation Oncology, Peking University 3rd Hospital, Beijing 100191, China
| | - 善智 古
- 410013 长沙, 湖南省肿瘤医院放射介入科Department of Interventional Therapy, Hunan Provincial Tumor Hospital, Changsha 410013, China
| | - 威健 冯
- 100045 北京, 首都医科大学附属复兴医院肿瘤科Department of Oncology, Fuxing Hospital Affiliated to the Capital University of Medical Sciences, Beijing 100045, China
| | - 一平 庄
- 210009 南京, 江苏省肿瘤医院介入科Department of Interventional Therapy, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - 宝东 刘
- 100053 北京, 首都医科大学宣武医院胸外科Department of Thoracic Surgery, Xuanwu Hospital Affiliated to the Capital University of Medical Sciences, Beijing 100053, China
| | - 晓光 李
- 100005 北京, 北京医院肿瘤微创中心Department of Tumor Minimally Invasive Therapy, Beijing Hospital, Beijing 100005, China
| | - 玉亮 李
- 250033 济南, 山东大学第二医院介入治疗中心Interventional Treatment Center, Shandong University Second Hospital, Ji'nan 250033, China
| | - 坡 杨
- 150001 哈尔滨, 哈尔滨医科大学第四人民医院介入放射科Department of Interventional Radiology, The Fourth Hospital of Harbin Medical University, Harbin 150001, China
| | - 霞 杨
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - 武威 杨
- 100071 北京, 解放军307医院肿瘤微创治疗科Department of Tumor Minimally Invasive Therapy, 307 Hospital, Beijing 100071, China
| | - 俊辉 陈
- 510060 广州, 中山大学肿瘤医院影像与微创介入中心Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - 嵘 张
- 518036 深圳, 北京大学深圳医院微创介入科Department of Minimally Invasive Interventional Therapy, Shenzhen Hospital of Beijing University, Shenzhen 518036, China
| | - 征宇 林
- 350005 福州, 福建医科大学附属第一医院介入科Department of Interventional Therapy, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - 志强 孟
- 200032 上海, 复旦大学肿瘤医院微创治疗科Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - 凯文 胡
- 100078 北京, 北京中医药大学东方医院肿瘤科Department of Oncology, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100078, China
| | - 晨 柳
- 100083 北京, 北京肿瘤医院介入治疗科Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100083, China
| | - 忠民 彭
- 250014 济南, 山东省立医院胸外科Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - 玥 韩
- 100021 北京, 中国医学科学院肿瘤医院介入治疗科Department of Interventional Therapy, Tumor Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
| | - 勇 靳
- 215004 苏州, 苏州大学第二附属医院介入治疗科Department of Interventional Therapy, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - 光焰 雷
- 710061 西安, 陕西省肿瘤医院胸外科Department of Thoracic Surgery, Shanxi Provincial Tumor Hospital, Xi'an 710061, China
| | - 博 翟
- 200127 上海, 上海交通大学仁济医院肿瘤介入治疗科Tumor Interventional Therapy Center, Shanghai Renji Hospital, Shanghai 200127, China
| | - 广慧 黄
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
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Zielinski M, Zaimi R, Sabatier P, Bagan P. Is radiofrequency ablation of lung metastases the most radical treatment? Eur J Surg Oncol 2015; 42:149-50. [PMID: 26437855 DOI: 10.1016/j.ejso.2015.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - R Zaimi
- Department of Thoracic and Vascular, CH Victor Dupouy, Argenteuil, France
| | - P Sabatier
- Department of Pathology, CH Victor Dupouy, Argenteuil, France
| | - P Bagan
- Department of Thoracic and Vascular, CH Victor Dupouy, Argenteuil, France.
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Ye X, Fan W. [Expert consensus for thermal ablation of primary and metastatic lung tumors]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 17:294-301. [PMID: 24758903 PMCID: PMC6000017 DOI: 10.3779/j.issn.1009-3419.2014.04.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - Weijun Fan
- Imaging Intervention Center, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
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Ye X, Fan W, Chen JH, Feng WJ, Gu SZ, Han Y, Huang GH, Lei GY, Li XG, Li YL, Li ZJ, Lin ZY, Liu BD, Liu Y, Peng ZM, Wang H, Yang WW, Yang X, Zhai B, Zhang J. Chinese expert consensus workshop report: Guidelines for thermal ablation of primary and metastatic lung tumors. Thorac Cancer 2015; 6:112-21. [PMID: 26273346 PMCID: PMC4448461 DOI: 10.1111/1759-7714.12152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/16/2014] [Indexed: 12/31/2022] Open
Abstract
Although surgical resection is the primary means of curing both primary and metastatic lung cancers, about 80% of lung cancers cannot be removed by surgery. As most patients with unresectable lung cancer receive only limited benefits from traditional radiotherapy and chemotherapy, many new local treatment methods have emerged, including local ablation therapy. The Minimally Invasive and Comprehensive Treatment of Lung Cancer Branch, Professional Committee of Minimally Invasive Treatment of Cancer of the Chinese Anti-Cancer Association has organized multidisciplinary experts to develop guidelines for this treatment modality. These guidelines aim at standardizing thermal ablation procedures and criteria for selecting treatment candidates and assessing outcomes; and for preventing and managing post-ablation complications.
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Affiliation(s)
- Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Weijun Fan
- Imaging and Interventional Center, Sun Yat-sen University Cancer CenterGuangzhou, China
| | - Jun-hui Chen
- Department of Minimally Invasive Interventional Therapy, Shenzhen Hospital of Beijing UniversityShenzhen, China
| | - Wei-jian Feng
- Department of Oncology, Fuxing Hospital Affiliated to the Capital University of Medical SciencesBeijing, China
| | - Shan-zhi Gu
- Department of Interventional Therapy, Hunan Provincial Tumor HospitalChangsha, China
| | - Yue Han
- Department of Imaging, Tumor Institute and Hospital, Chinese Academy of Medical SciencesBeijing, China
| | - Guang-hui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Guang-yan Lei
- Department of Thoracic Surgery, Shanxi Provincial Tumor HospitalXi'an, China
| | - Xiao-guang Li
- Department of Radiology, Peking Union Medical College HospitalBeijing, China
| | - Yu-liang Li
- Interventional Treatment Center, Shandong University Second HospitalJinan, China
| | - Zhen-jia Li
- Research Office of CT Diagnosis and Treatment, Shandong Provincial Institute of Medical ImagingJinan, China
| | - Zheng-yu Lin
- Department of Interventional Therapy, the First Affiliated Hospital of Fujian Medical UniversityFuzhou, China
| | - Bao-dong Liu
- Department of Thoracic Surgery, Xuanwu Hospital Affiliated to the Capital University of Medical SciencesBeijing, China
| | - Ying Liu
- Department of Oncology, Armed Police Hospital of Guangdong ProvinceGuangzhou, China
| | - Zhong-min Peng
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Hui Wang
- Interventional Treatment Center, Jilin Provincial Tumor HospitalChangchun, China
| | - Wu-wei Yang
- Department of Tumor Minimally Invasive Therapy, 307 HospitalBeijing, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Bo Zhai
- Tumor Interventional Therapy Center, Shanghai Renji HospitalShanghai, China
| | - Jun Zhang
- Center of Lung Cancer, the First Affiliated Hospital of China Medical UniversityShenyang, China
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Valcavi R, Piana S, Bortolan GS, Lai R, Barbieri V, Negro R. Ultrasound-guided percutaneous laser ablation of papillary thyroid microcarcinoma: a feasibility study on three cases with pathological and immunohistochemical evaluation. Thyroid 2013; 23:1578-82. [PMID: 23978269 DOI: 10.1089/thy.2013.0279] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Ultrasound-guided thermal laser ablation (LA) is a nonsurgical technique that has been proposed, but not fully assessed, for papillary thyroid microcarcinoma (PTMC) treatment. The objectives of this study were to evaluate the clinical feasibility of LA on PTMC as a primary treatment and to prove histologically the absence of residual viable tumor after LA procedure. METHODS Three patients with a Thy 6 diagnosis at fine-needle aspiration cytology with a single PTMC smaller than 10 mm volunteered after full explanation of the protocol. At ultrasound examination, patients had no extrathyroid extension and no evidence of lymph node metastasis. Patients underwent percutaneous ultrasound-assisted LA of the PTMC in the operating room under general anesthesia. One 300 μm plane-cut optic fiber was inserted through the sheath of 21G Chiba needle, exposing 5 mm of the nude fiber in direct contact with tumor tissue, and connected with a laser source operating at 1.064 μm with 3 W output power. Total energy delivery was 1800 J. The surgeon directly started a standard total thyroidectomy. During surgical inspection, no remarkable laser sign was observed in the muscles, the perithyroidal tissues, or the recurrent laryngeal nerves. RESULTS Conventional histology showed destructured and carbonized tissue. Lack of vitality was demonstrated by complete loss of TTF1 and antimitochondria antibody expression in the whole ablated area and in the rim of normal tissue surrounding the tumor. BRAF V600E mutation was detected in cases 1 and 2. Furthermore, in cases 2 and 3, incidental papillary microfoci were found. A lymph node micrometastasis (200 μm) was observed in case 2. CONCLUSIONS This study demonstrates that percutaneous LA is technically feasible for complete PTMC destruction. Now, LA may be useful in selected patients with PTMC, either when the surgeon or a patient refuses surgery, or when the patient is at high risk for an operation. LA may become a primary choice of treatment for PTMC only if future new knowledge would permit preoperative recognition of multifocality and lymph node metastasis.
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Affiliation(s)
- Roberto Valcavi
- 1 Endocrinology Unit, Arcispedale Santa Maria Nuova and Clinical Cancer Research Institute (IRCCS) , Reggio Emilia, Italy
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Legras A, Mordant P, Cazes A, Riquet M. [Radiofrequency of lung metastases: should initial pneumothorax predict treatment failure?]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:336-339. [PMID: 24051188 DOI: 10.1016/j.pneumo.2013.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/01/2013] [Accepted: 04/09/2013] [Indexed: 06/02/2023]
Abstract
In the management of lung metastases originating from colorectal cancer, RFA is particularly indicated in case of major comorbidities contraindicating thoracic surgery or recurrent disease after previous ipsilateral resection. The most frequent complication of RFA is pneumothorax, requiring chest tube insertion in 5% of cases. Interestingly, this proportion is very close to the rate of local recurrence, suggesting a possible association. We report a case of RFA followed by intractable pneumothorax requiring surgical management, and leading to the diagnosis of residual tumour. This case report illustrates this association and questions its relevance.
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Affiliation(s)
- A Legras
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - P Mordant
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Cazes
- Service d'anatomie pathologique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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Ceppa DP, Kosinski AS, Berry MF, Tong BC, Harpole DH, Mitchell JD, D'Amico TA, Onaitis MW. Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis. Ann Surg 2012; 256:487-93. [PMID: 22868367 PMCID: PMC4089858 DOI: 10.1097/sla.0b013e318265819c] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Using a national database, we asked whether video-assisted thoracoscopic surgery (VATS) lobectomy is beneficial in high-risk pulmonary patients. BACKGROUND Single-institution series demonstrated benefit of VATS lobectomy over lobectomy via thoracotomy in poor pulmonary function patients [FEV1 (forced expiratory volume in 1 second) or DLCO (diffusion capacity of the lung to carbon monoxide) <60% predicted]. METHODS The STS General Thoracic Database was queried for patients having undergone lobectomy by either thoracotomy or VATS between 2000 and 2010. Postoperative pulmonary complications included those defined by the STS database. RESULTS In the STS database, 12,970 patients underwent lobectomy (thoracotomy, n = 8439; VATS, n = 4531) and met inclusion criteria. The overall rate of pulmonary complications was 21.7% (1832/8439) and 17.8% (806/4531) in patients undergoing lobectomy with thoracotomy and VATS, respectively (P < 0.0001). In a multivariable model of pulmonary complications, thoracotomy approach (OR = 1.25, P < 0.001), decreasing FEV1% predicted (OR = 1.01 per unit, P < 0.001) and DLCO% predicted (OR = 1.01 per unit, P < 0.001), and increasing age (1.02 per year, P < 0.001) independently predicted pulmonary complications. When examining pulmonary complications in patients with FEV1 less than 60% predicted, thoracotomy patients have markedly increased pulmonary complications when compared with VATS patients (P = 0.023). No significant difference is noted with FEV1 more than 60% predicted. CONCLUSIONS Poor pulmonary function predicts respiratory complications regardless of approach. Respiratory complications increase at a significantly greater rate in lobectomy patients with poor pulmonary function after thoracotomy compared with VATS. Planned surgical approach should be considered while determining whether a high-risk patient is an appropriate resection candidate.
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Affiliation(s)
- DuyKhanh P Ceppa
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA.
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Additional Pulmonary Nodules in the Patient with Lung Cancer: Controversies and Challenges. Clin Chest Med 2011; 32:811-25. [DOI: 10.1016/j.ccm.2011.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lesser TG, Ritter F, Schlosser H, Boltze C, Hackenbroich C. Effects of radiofrequency ablation on normal lung tissue in a swine model. Acad Radiol 2011; 18:1318-23. [PMID: 21893298 DOI: 10.1016/j.acra.2011.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 06/13/2011] [Accepted: 06/17/2011] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To determine the effect of radiofrequency (RF) ablation on normal lung tissue in an animal model. MATERIALS AND METHODS RF ablation of lung tissue was performed on eight swine under computed tomographic control. Group A (n = 4) received peripheral ablation (subpleural needle placement) and group B (n = 4) received central ablation (hilar needle placement). RF ablation was applied via a single 4.5-gauge internally cooled electrode with a 2-cm tip for 12 minutes. The ablation was monitored with computed tomography at 3, 7, and 12 minutes, and 10 minutes after ablation. After 3, 7, 40, and 60 days, computed tomography was performed, and the animals were sacrificed to examine the lung tissue both macroscopically and histopathologically. RESULTS There were no deaths from RF ablation. In group A, coagulative necrosis was resorbed almost completely and transformed into a fibrotic scar after 60 days. No pneumothorax, pleural effusion, or lung abscess was observed. In group B, there was also a transformation of the necrosis into connective tissue. Neither the pulmonary vessels nor the bronchi of the hilum abutting the coagulative necrosis were damaged. After 60 days, no vascular thrombosis, bleeding, aneurysm, bronchial stenosis, or bronchopulmonary fistula was observed. CONCLUSION RF ablation of lung tissue affects coagulation necrosis, causing scar transformation. There was no damage to either great vessels or bronchi. The application of RF ablation for tumors located in or near functional structures appears feasible without severe complications.
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Jaskolka JD, Kachura JR, Hwang DM, Tsao MS, Waddell TK, Asch MR, Darling GE, Johnston MR. Pathologic Assessment of Radiofrequency Ablation of Pulmonary Metastases. J Vasc Interv Radiol 2010; 21:1689-96. [DOI: 10.1016/j.jvir.2010.06.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Revised: 06/08/2010] [Accepted: 06/15/2010] [Indexed: 01/20/2023] Open
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Schneider T, Reuss D, Warth A, Schnabel PA, von Deimling A, Herth FJF, Dienemann H, Hoffmann H. The efficacy of bipolar and multipolar radiofrequency ablation of lung neoplasms - results of an ablate and resect study. Eur J Cardiothorac Surg 2010; 39:968-73. [PMID: 20961771 DOI: 10.1016/j.ejcts.2010.08.055] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 08/05/2010] [Accepted: 08/23/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Radiofrequency ablation (RFA) has obtained increasing attention as an interventional approach for the local treatment of primary and secondary lung neoplasms. The local effect of the procedure is usually controlled by radiologic means. The objectives of this 'ablate and resect' study were to investigate the efficacy of bipolar and multipolar RFA by histologic evaluation and to compare the two techniques. METHODS In a total of 32 subjects with histologically proven non-small-cell lung cancer or pulmonary metastases from an extrathoracic primary tumor, bipolar, or multipolar RFA was performed during open thoracotomy. Curative resection (lobectomy or wedge resection including mediastinal lymph node dissection) was performed subsequently. The extent of cell death and early histologic findings following RFA were determined by histology and immunohistochemistry (nicotinamide adenine dinucleotide (NADH) and monoclonal anti-mitochondrial antibodies MAB 1273). RESULTS Intra-operative bipolar and multipolar RFA is a safe procedure, and there was no bleeding or thermal damage of the lung tissue. Routine histologic staining could not identify tumor cell death. However, immunohistochemistry was able to verify cell death in the ablated tumor tissue. Complete tumor cell necrosis was determined in 12 tumors (37.5%); and scattered vital tumor tissue was detected in 16 tumors (50%). Incomplete ablation with a ratio of >20% vital tumor tissue was found in four tumors (12.5%), particularly surrounding vascular structures within the tumor tissue or in marginal zones of the tumor tissue. The local efficacy of bipolar and multipolar RFA was comparable, and incomplete ablations were found only in adenocarcinoma. CONCLUSIONS Bipolar and multipolar RFA in an open thoracotomy setting is a technically feasible and safe procedure. Early immunohistochemical findings after RFA showed complete tumor cell necrosis in 38% of cases. The high rate of viable tumor cells remaining after ablation casts doubt on RFA as a curative concept. This approach should be reserved for palliative indications. Patients fulfilling the criteria for curative resection should not be denied surgery.
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Affiliation(s)
- Thomas Schneider
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
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Zheng Y, Fernando HC. Surgical and Nonresectional Therapies for Pulmonary Metastasis. Surg Clin North Am 2010; 90:1041-51. [DOI: 10.1016/j.suc.2010.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Yoon YS, Kim HK, Kim J, Choi YS, Shim YM, Paik SW, Kim K. Long-term survival and prognostic factors after pulmonary metastasectomy in hepatocellular carcinoma. Ann Surg Oncol 2010; 17:2795-801. [PMID: 20517683 DOI: 10.1245/s10434-010-1073-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Indexed: 12/27/2022]
Abstract
BACKGROUND The lung is the most common site of extrahepatic recurrence from hepatocellular carcinoma (HCC), but the standard treatment for pulmonary metastasis (PM) from HCC has not been established. We analyzed patients who underwent pulmonary resection for HCC metastases to evaluate long-term survival and prognostic factors. METHODS We retrospectively reviewed patients who underwent pulmonary metastasectomy due to HCC at Samsung Medical Center between 1998 and 2008. Clinical/pathological features and prognoses were investigated. RESULTS Fifty-two pulmonary metastasectomies were performed in 45 patients (38 men) with PM. Average patient age was 50.9 ± 11.0 years. Video-assisted thoracic surgery was used in 24 patients. Lobectomy was performed in eight patients and wedge resection in the others. Median survival after pulmonary metastasectomies was 40.7 months, and the 5-year overall survival rate was 37%. First recurrence in lung (P = 0.03), a long disease-free interval (P = 0.02), and solitary PM (P = 0.03) were found to be favorably associated with overall survival by univariate analysis. However, multivariate analysis failed to identify any independent prognostic factor associated with survival. Nevertheless, first recurrence in lung was found to be a favorable factor of PM-free survival by univariate (P = 0.01) and multivariate analyses (P = 0.022, hazard ratio = 0.382). CONCLUSIONS Pulmonary metastasectomies in selected patients with HCC was found to have a relatively good survival rate. Although no independent prognostic factor was found to be associated with overall survival, pulmonary metastasectomy may be effective in patients with a single PM and a long disease-free interval.
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Affiliation(s)
- Yoo Sang Yoon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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16
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Hoffmann H, Dienemann H. [Development of thoracic surgery over the next 20 years]. Chirurg 2009; 80:1121-5. [PMID: 19924358 DOI: 10.1007/s00104-009-1775-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Thoracic surgery is one of the self-contained surgical disciplines with an above average large potential over the next 20 years. An increase in mortality due to pulmonary diseases is to be expected worldwide. Bronchial carcinoma is the most common diagnosis in thoracic surgery patients and will remain a relevant topic for health politics for many years. However, the adequate treatment of these patients demands a high degree of interdisciplinary cooperation. In the future thoracic surgery will therefore be carried out in centres with an organ-dependent and interdisciplinary structure. From a surgical technical perspective minimally invasive operation strategies will become established for standard interventions, which are indispensible components of the repertoire for thoracic surgery. Thoracic surgery is traditionally a clinically oriented discipline with low academic superstructure and a high backlog demand in nearly all areas of research. It offers a large field of activity for the next scientifically interested generation with excellent chances to become established and succeed in this discipline with a very promising future.
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Affiliation(s)
- H Hoffmann
- Chirurgische Abteilung, Thoraxklinik am Universitätsklinikum, Universität Heidelberg, Amalienstrasse 5, Heidelberg, Germany.
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17
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Chang AC. Invited commentary. Ann Thorac Surg 2009; 87:384. [PMID: 19161743 DOI: 10.1016/j.athoracsur.2008.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Revised: 11/16/2008] [Accepted: 11/20/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew C Chang
- Department of Surgery, University of Michigan Medical Center, TC2120G/5344, 1500 East Medical Center Dr, Ann Arbor, MI 48109, USA.
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Younes RN, Gross JL, Taira AM, Martins AAC, Neves GS. Surgical resection of lung metastases: results from 529 patients. Clinics (Sao Paulo) 2009; 64:535-41. [PMID: 19578657 PMCID: PMC2705143 DOI: 10.1590/s1807-59322009000600008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 03/13/2009] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of this study is to determine clinical, pathological, and treatment-relevant variables associated with long-term (90-month) overall survival in patients with lung metastases undergoing pulmonary metastasectomy. METHODS A retrospective review was performed of patients who were admitted with lung metastases, and who underwent thoracotomy for resection, after treatment of a primary tumor. Data were collected regarding demographics, tumor features, treatment, and outcome. RESULTS Patients (n = 529) were submitted to a total of 776 thoracotomies. Median follow-up time across all patients was 21.6 months (range: 0-192 months). The postoperative complication rate was 9.3%, and the 30-day mortality rate was 0.2%. The ninety-month overall survival rate for all patients was 30.4%. Multivariate analysis identified the number of pulmonary nodules detected on preoperative CT-scan, the number of malignant nodules resected, and complete resection as the independent prognostic factors for overall survival. CONCLUSION These results confirm that lung metastasectomy is a safe and potentially curative procedure for patients with treated primary tumors. A select group of patients can achieve long-term survival after resection.
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Affiliation(s)
- Riad N Younes
- Department of Thoracic Surgery, Hospital do Cancer AC Camargo, São Paulo, Brazil.
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