Percutaneous thermal ablation of primary and secondary lung tumors: Comparison between microwave and radiofrequency ablation

PURPOSE

The purpose of this study was to retrospectively compare microwave (MWA) and radiofrequency (RFA) ablation in the percutaneous treatment of primary and secondary lung tumors.

MATERIAL AND METHODS

A total of 115 patients with a total of 160 lung tumors (primary, n=41; secondary, n=119) were retrospectively included. There were 56 men and 59 women with a mean age of 67.8±12.7 (SD) years (range: 42-89 years) who underwent either MWA (61 patients; 79 tumors) or RFA (54 patients; 81 tumors). The primary study endpoints were local recurrence during follow-up and the incidence of complications during and following thermal ablation. The MWA and RFA groups were compared in terms of treatment efficacy and complication rates.

RESULTS

Demographics were similar in the two groups. Mean tumor diameter was smaller in RFA group (13.1±5.1 [SD] mm; range: 4-27mm) than in MWA group (17.1±8.3 [SD] mm; range: 5-36mm) (P<0.001). Ablation volumes at one month were 24.1±21.7 (SD) cm³ (range: 2-97.8 cm³) in RFA group and 30.2±35.9 (SD) cm³ (range: 1.9-243.8 cm³) in MWA group (P=0.195). During a mean overall follow-up duration of 488±407 (SD) days (range: 30-1508 days), 9/160 tumors (5.6%) developed local recurrence: six (6/79; 7.6%) in the RFA group and three (3/81; 3.7%) in the MWA group (P=0.32). Pneumothoraces were more frequent in the RFA group (32/79; 40.5%) than in the MWA group (20/81; 24.7%) (P=0.049). The mean length of hospital stay was 4.5±3.7 (SD) days (range: 1-25 days) in the RFA group and 4.7±4.6 (SD) days (range: 2-25 days) in the MWA group (P=0.76).

CONCLUSIONS

MWA favorably compares with RFA and can be considered as an effective and safe thermal ablation technique for lung tumors, especially in situations where RFA has limited efficacy.

Is the Outcome of Pulmonary Resections due to Non-Small Cell Lung Cancer in Octogenarian Patients Worse?

Purpose: Lung cancer is one of the major sources of mortality in the elderly. This study was undertaken to assess the early and long-term results of surgical resection in patients older than 70 years of age by comparing the results of patients aged 70–79 years (group 1) with patients older than 80 years of age (group 2).

Methods: Data on patient age, gender, spirometry values, side, size, histology and stage of the tumor, surgical procedures, postoperative complications, Charlson comorbidity scores (CCS), and survival were collected.

Results: After 1–2 propensity score matching group 1 (70–79 years) included 84 and group 2 (age over 80) 42 cases. The multivariate analysis showed that CCS was the only significant factor affecting the development of complications (p = 0.003). The overall median and 5-year survival of all patients were 55 months and 42.5%, respectively. Although the survival of the elderly group 2 was higher than the first group, the difference did not reach significance (50 vs. 49 months, respectively).

Conclusion: The outcomes of surgery in terms of morbidity and mortality rates do not differ between the two age groups. The safety of pulmonary resections in the elderly group is comparable to patients under 70 years if the comorbidities are appropriately controlled. In addition, surgery provides satisfactory survival rates in both age groups.

Impact of video-assisted thoracic surgery approach on postoperative mortality after lobectomy in octogenarians

OBJECTIVE

The number of octogenarians who present with localized lung cancer eligible for surgical resection is increasing. Video-assisted thoracic surgery lobectomy has been widely accepted, but the potential benefit in octogenarians is not well established, especially for postoperative mortality. This study aimed to assess the impact of a video-assisted thoracic surgery approach on postoperative mortality after lobectomy for lung cancer in octogenarians.

METHODS

From January 2005 to December 2016, all patients aged more than 80 years who received lobectomy treatment for lung cancer were retrieved from the French Administrative Database. The end point was 30-day postoperative death. A propensity score was generated with 16 pretreatment variables and used to create balanced groups with matching (578 matches 1:1). Results are reported as odds ratios and 95% confidence intervals.

RESULTS

Of the 75,892 patients operated for lobectomy during this period, 3560 were octogenarians. Video-assisted thoracic surgery was performed in 16.7% (n = 597) of cases, and thoracotomy was performed in 83.23% (n = 2963) of cases. From 2005 to 2016, the number of patients aged more than 80 years who were operated for lung cancer increased from 160 to 456 patients per year, and the proportion of lobectomy performed by video-assisted thoracic surgery increased as well (from 3.13% to 37.28%). Unmatched postoperative mortality was 3.85% (n = 23) for video-assisted thoracic surgery versus 7.9% (n = 234) for thoracotomy (P < .0001). Matched postoperative mortality was significantly lower in the video-assisted thoracic surgery approach with an odds ratio of 0.51 (95% confidence interval, 0.27-0.96; P = .038).

CONCLUSIONS

Video-assisted thoracic surgery was significantly associated with reduced postoperative mortality compared with open thoracotomy after lobectomy for lung cancer in octogenarians.

Does age over 80 years have to be a contraindication for lung cancer surgery-a nationwide database study

BACKGROUND

Nowadays surgery remains the best treatment for localized lung cancer (LC). However, patients over 80 years old are often denied surgery because of the postoperative risk of death. This study aimed to estimate in-hospital mortality (IHM) and determine whether age over 80 is the most important predictor of IHM after LC surgery.

METHODS

From January 2005 to December 2015, 97,440 patients, including 4,438 patients over 80 years old, were operated on for LC and recorded in the French Administrative Database. Characteristics of patients, hospitals and surgery were analysed.

RESULTS

Crude IHM was 3.73% (n=3,639) and 7.77% (n=345) for the over 80s vs. 3.54% (n=3,294) for younger patients (P<0.0001). In multivariate analysis, predictive factors for IHM with the odds ratios (OR) were: 2.60 for age ≥80 (95% CI: 2.30-2.94; P=0.0001), 5.85 for a previous liver disease (95% CI: 4.79-7.16; P=0.0001) and 5 for previous lung disease (95% CI: 4.25-5.9; P=0.0001). IHM was also linked to hospital volume with an OR of 0.75 (95% CI: 0.69-0.81; P=0.0001) and a linear decrease for predicted IHM according to hospital volume for the over 80s. Adjusted ORs were 1.15 (95% CI: 0.96-1.4; P=0.0116) for lobectomy, 2.18 for bilobectomy (95% CI: 1.7-2.8; P=0.0001) and 3.83 (95% CI: 3.2-4.6; P=0.0001) for pneumonectomy.

CONCLUSIONS

Concerning IHM, age ≥80 had a lower weight than did a previous pulmonary or liver disease and the type of pulmonary resection. Patients over 80s with localized LC and no significant comorbidities should be referred for surgery if lobectomy or sublobar resection could be performed.