Risk of persistent air leaks following percutaneous cryoablation and microwave ablation of peripheral lung tumors
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330_2023_9499_ReferencePDF.pdf
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Author(s)
Abrishami Kashani, Maya
Murphy, Mark C.
Saenger, Jonathan A.
Wrobel, Maria M.
Tahir, Ismail
Mrah, Sofiane
Ringer, Stefan
Bunck, Alexander C.
Silverman, Stuart G.
Shyn, Paul B.
Date Issued
March 9, 2023
Publisher
Springer Berlin Heidelberg
Citation
Abrishami Kashani, Maya, Murphy, Mark C., Saenger, Jonathan A., Wrobel, Maria M., Tahir, Ismail et al. 2023. "Risk of persistent air leaks following percutaneous cryoablation and microwave ablation of peripheral lung tumors."
Version
Author's final manuscript
Abstract
Abstract
Objectives
To compare the incidence of persistent air leak (PAL) following cryoablation vs MWA of lung tumors when the ablation zone includes the pleura.
Methods
This bi-institutional retrospective cohort study evaluated consecutive peripheral lung tumors treated with cryoablation or MWA from 2006 to 2021. PAL was defined as an air leak for more than 24 h after chest tube placement or an enlarging postprocedural pneumothorax requiring chest tube placement. The pleural area included by the ablation zone was quantified on CT using semi-automated segmentation. PAL incidence was compared between ablation modalities and a parsimonious multivariable model was developed to assess the odds of PAL using generalized estimating equations and purposeful selection of predefined covariates. Time-to-local tumor progression (LTP) was compared between ablation modalities using Fine-Gray models, with death as a competing risk.
Results
In total, 260 tumors (mean diameter, 13.1 mm ± 7.4; mean distance to pleura, 3.6 mm ± 5.2) in 116 patients (mean age, 61.1 years ± 15.3; 60 women) and 173 sessions (112 cryoablations, 61 MWA) were included. PAL occurred after 25/173 (15%) sessions. The incidence was significantly lower following cryoablation compared to MWA (10 [9%] vs 15 [25%]; p = .006). The odds of PAL adjusted for the number of treated tumors per session were 67% lower following cryoablation (odds ratio = 0.33 [95% CI, 0.14–0.82]; p = .02) vs MWA. There was no significant difference in time-to-LTP between ablation modalities (p = .36).
Conclusions
Cryoablation of peripheral lung tumors bears a lower risk of PAL compared to MWA when the ablation zone includes the pleura, without adversely affecting time-to-LTP.
Key Points
• The incidence of persistent air leaks after percutaneous ablation of peripheral lung tumors was lower following cryoablation compared to microwave ablation (9% vs 25%; p = .006).
• The mean chest tube dwell time was 54% shorter following cryoablation compared to MWA (p = .04).
• Local tumor progression did not differ between lung tumors treated with percutaneous cryoablation compared to microwave ablation (p = .36).
MIT Department
Sloan School of Management
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DOI of Published Version
https://doi.org/10.1007/s00330-023-09499-y
