Image-guided combined ablation and resection in thoracic surgery for the treatment of multiple pulmonary metastases: A preliminary case series

Abstract

Objectives To demonstrate the feasibility and preliminary outcomes of a novel hybrid technique combining percutaneous microwave ablation and wire-assisted wedge resection for patients with multiple pulmonary metastases using intraoperative imaging. Methods We describe our technique and present a retrospective case series of 4 patients undergoing iCART at our institution between August 2018 and January 2020. Procedures were performed in a hybrid operating suite using the ARTIS Pheno cone beam computerized tomography scanner (Siemens Healthineers, Erlangen, German). Patient information included past history of malignancy as well as lesion size, depth, location, and histology result. Surgical complications and length of stay were also recorded. Results Five procedures were performed on 4 patients during the study period. One patient underwent bilateral procedures 4 weeks apart. All patients underwent at least 1 ablation and 1 wedge resection during the combined procedure. Patient ages ranged from 40 to 66 years and the majority (75%) were men. All had a past history of cancer. Lesions were treated in every lobe. Size and depth ranged from 6 to 24 mm and 21 to 33 mm, respectively, for ablated nodules and 5 to 27 mm and 0 to 22 mm, respectively, for the wedge resected nodules. Three procedures were completed uniportal and operative time ranged from 51 to 210 minutes. All cases sustained <10 mL blood loss. There were 2 intraoperative pneumothorax, 1 prevented successful completion of the ablation. One patient required a prolonged period of postoperative physiotherapy and was discharged on day 6. The other patients were discharged on postoperative day 2 or 3. All 5 histology specimens confirmed metastatic disease. Conclusions Our hybrid approach provides a minimally invasive and comprehensive personalized therapy for patients with multiple pulmonary metastases under a single general anesthetic. It provides histology-based diagnosis whilst minimizing lung tissue loss and eliminating the need for transfer from radiology to operating theatre. Emergence of ablation as a treatment for stage 1 non–small cell lung cancer and the expansion of lung cancer screening may widen the application of iCART in the future.

Thoracoscopic pulmonary resection combined with real-time image-guided percutaneous ablation for multiple pulmonary nodules: a novel surgical approach and literature review

“…To date, similar therapeutic strategy which combined wedge resection and microwave ablation has been applied by surgeons to treat patients with lung metastases from malignant tumors ( 12 ), but have not yet been reported for the treatment of sMPLC. Although this novel surgical strategy may become a superior treatment option for sMPLC, there is still a lack of data on its feasibility, safety, and oncologic efficacy.…”

Hybrid operating room applications for precision hepatobiliary surgery: A narrative review

“…Theoretically, a hybrid OR could allow CT‐guided ablations to be combined with resection under the same anesthesia. The feasibility of this has been demonstrated in thoracic surgery for the resection and ablation of pulmonary metastases 70 . Moreover, Banz et al demonstrated how preoperative CT‐scans can be integrated with intraoperative instrumentation and ultrasound to successfully ablate and resect bilobar colorectal liver metastases 71 .…”

“…Image source 48. of this has been demonstrated in thoracic surgery for the resection and ablation of pulmonary metastases 70. Moreover, Banz et al demonstrated how preoperative CT-scans can be integrated with intraoperative instrumentation and ultrasound to successfully ablate…”

Commentary: Temerity trumps dogma: The dangerous road of innovation

“…We congratulate Harrison and colleagues 1 on their article concerning image-guided combined ablation and resection therapy, or “iCART,” as the authors unfortunately brand it. The article shows innovation and helps blaze the trial for our inevitable future.…”