Hybrid treatment of multifocal lung malignancy by concomitant transbronchial microwave ablation with same-session lung resection and post-lung resection ablation.

Objectives: Transbronchial microwave ablation may have additional value when performed with the same-session lung resection or in patients with a history of lung resection(s). We present our institutional cohort to assess the feasibility and safety of transbronchial microwave ablation with the presence of lung resection.

Methods: From March 2019 to February 2024, 92 patients who underwent transbronchial microwave ablation with either a history of major lung resection(s) or same-session ablation with concomitant video-assisted thoracoscopic lung resection(s) were included in this study. Procedural details, safety outcomes and length of stay were retrospectively analysed.

Results: There were 103 episodes of transbronchial microwave ablation performed, and 142 lung lesions were ablated. The average size of nodules was 11.80 mm. Technical success was 100% with a mean minimum margin of 6 mm. Complications occurred in 23 procedures; the majority were CTCAE grade 1 complications (74%), which resolved shortly with observation, and the rest were grade 2 and 3 complications (13%), including one case of bronchopleural fistula and two cases of pneumothorax that required drainage. The average length of stay was 1.46 days. A total of 11 cases of same-session ablation with lung resection were performed. The average procedural time was 226 min, which is significantly shorter than the 27 cases of separate surgery and ablation during the same period (P = 0.012).

Conclusions: Performing transbronchial microwave ablation utilizing electromagnetic navigation bronchoscopic guidance is feasible and safe in the background of lung resection. This technique can also be incorporated into a one-stop treatment with concomitant lung resection.