Surgical Outcomes of Video-Assisted Thoracic Surgery Combined With Computed Tomography-Guided Microwave Ablation for Lung Cancer Presenting as Multiple Ground-Glass Opacities: A 5-Year Retrospective Cohort Study.

BACKGROUND

Multiple ground glass opacities (mGGOs) are frequently observed in patients with early-stage lung adenocarcinoma. The most appropriate and effective treatment for these mGGOs remains controversial. The purpose of this study was to retrospectively review the usefulness and safety of performing video-assisted thoracic surgery (VATS) combined with computed tomography (CT)-guided microwave ablation (MWA) in patients with synchronous multiple primary lung cancer (sMPLC) and to demonstrate the long-term surgical outcomes at our institute.

MATERIALS AND METHODS

From April 2019 to December 2021, we enrolled 47 patients who underwent VATS combined with CT-guided MWA for mGGOs. Comprehensive data regarding the enrolled subjects, including clinical features, imaging findings, histopathological characteristics, and surgical records, were meticulously extracted from the surgical database and electronic medical records. The outcomes assessed in this study included the feasibility and safety profile of the combined procedure, as well as event-free survival (EFS), local progression-free survival (LPFS), and overall survival (OS).

RESULTS

A total of 47 patients with sMPLC characterized by mGGOs underwent VATS combined with CT-guided MWA. In this cohort, 173 GGOs were removed, including 69 nodules (39.9%) larger than 8 mm and 104 nodules (60.1%) measuring between 5 and 8 mm. We recorded all 58 types of VATS surgeries performed on 83 nodules. Additionally, 90 secondary nodules were treated with CT-guided MWA during either a single hospitalization or multiple hospitalizations (ranging from 1 to 4). We achieved a 100% technical success rate among the 47 patients. During the follow-up, there was no local tumor progression or recurrence among the 47 patients. Event-free survival was 100% at 3 years and 66.82% at 5 years, and the 5-year overall survival rate was 97.5%, with only one patient dying from an unrelated cause.

CONCLUSION

VATS combined with CT-guided MWA is a safe and effective method for patients with mGGOs. This combination marks the onset of an era where surgeons can utilize both a needle and a scalpel simultaneously.