Patel Prisha, Pal Koustav, Ahmed Hadi, Tang Bill, Paolucci Iwan, Khavandi Mohammad, Habibollahi Peiman, Shah Ketan, Huang Steven Y, Odisio Bruno C, Gupta Sanjay, Ahrar Kamran, Yevich Steven, Kuban Joshua D, Tam Alda, Sheth Rahul A
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
J Am Coll Radiol. 2025 May;22(5):550-560. doi: 10.1016/j.jacr.2024.12.006. Epub 2024 Dec 18.
To evaluate the relevance of established surgical risk calculators for predicting complications in patients undergoing percutaneous lung cryoablation (PLC).
The institution's database was queried for PLC procedures from March 2015 to May 2024, excluding those patients with concomitant local therapies or five or more lesions treated in a single setting. Demographics, frailty metrics as defined by the surgical literature, and procedural variables were collected. To evaluate the suitability of surgical risk estimate calculators, the requisite demographic data were input into the American College of Surgery surgical risk calculator; estimates for length of stay (LOS), serious complications, 30-day readmission, and mortality were calculated to determine the comparative risk profile were the patients to have undergone surgical wedge resection instead of PLC. Additionally, to evaluate the suitability of imaging predictors of complications, the volume of emphysematous lung was calculated using a machine learning algorithm and incorporated into a generalized estimating equation logistic regression analysis of other demographic and technical variables.
The study included 217 patients who underwent 314 procedures. Chest tubes were placed in 49% of procedures. The median LOS was 1 day (interquartile range: 1-1, range: 0-13). The median percentage of emphysema within the lungs was 5.9% (interquartile range: 2.4%-12.1%, range: 0.01%-50.3%). The median predicted surgical rates for serious complications (13.5%), 30-day readmission (12%), and 30-day mortality (5.9%) were all greater than actual rates after PLC (1.6%, 4.8%, and 0.3%, respectively). The estimated surgical LOS differed significantly from the actual PLC LOS (5 days versus 1 day, P < .001). In univariable analysis, the number of probes the number of tumors ablated (odds ratio 1.90, 95% confidence interval 1.18-3.05, P = .008) and the number of probes used (odds ratio 1.44, 95% confidence interval 1.06-1.96, P = .021) were significantly associated with increased LOS, but demographic and emphysema details were not.
Complications after PLC are significantly less frequent than the estimated complication risks for wedge resection in the same patient population. Risk estimate calculators tailored to PLC would help screen for high complication risks related to this procedure.
评估现有手术风险计算器对预测接受经皮肺冷冻消融术（PLC）患者并发症的相关性。
查询该机构2015年3月至2024年5月期间PLC手术的数据库，排除那些接受过联合局部治疗或单次治疗五个或更多病灶的患者。收集人口统计学数据、外科文献定义的虚弱指标以及手术变量。为评估手术风险评估计算器的适用性，将所需人口统计学数据输入美国外科医师学会手术风险计算器；计算住院时间（LOS）、严重并发症、30天再入院率和死亡率的估计值，以确定若患者接受手术楔形切除术而非PLC时的比较风险概况。此外，为评估并发症影像预测指标的适用性，使用机器学习算法计算肺气肿肺体积，并将其纳入其他人口统计学和技术变量的广义估计方程逻辑回归分析。
该研究纳入了217例接受314次手术的患者。49%的手术放置了胸管。中位LOS为1天（四分位间距：1 - 1，范围：0 - 13）。肺内肺气肿的中位百分比为5.9%（四分位间距：2.4% - 12.1%，范围：0.01% - 50.3%）。严重并发症（13.5%）、30天再入院率（12%）和30天死亡率（5.9%）的预测手术率中位数均高于PLC后的实际发生率（分别为1.6%、4.8%和0.3%）。估计的手术LOS与实际PLC LOS有显著差异（5天对1天，P <.001）。在单变量分析中，消融的肿瘤数量（比值比1.90，95%置信区间1.18 - 3.05，P =.008）和使用的探头数量（比值比1.44，95%置信区间1.06 - 1.96，P =.021）与LOS增加显著相关，但人口统计学和肺气肿细节无此关联。
在同一患者群体中，PLC后的并发症发生率明显低于楔形切除术的估计并发症风险。针对PLC定制的风险评估计算器将有助于筛查与该手术相关的高并发症风险。
