Safety and efficacy of simultaneous surgery and thermal ablation in sequential treatment of multiple primary lung cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIAO Congjia ^1,2 , HUANG Yuchen ¹ , DONG Zhenghao ¹ , ZHANG Jingwen ³ , SHEN Cheng ¹ ,  ZHOU Jian ¹ ,  LIAO Hu ¹

1. Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Thoracic Surgery, Shangjin Hospital of West China Hospital, Sichuan University / Chengdu Shangjin Nanfu Hospital, Chengdu, 610041, P. R. China;
3. West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

ZHOU Jian, Email: jian_zhou@wchscu.cn; LIAO Hu, Email: liaotiger_198653@163.com

Keywords：

Multiple primary lung cancer; surgery; ablation; safety; efficacy

DOI：

10.7507/1007-4848.202505071

Video：

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Objective To evaluate the safety and efficacy of simultaneous surgical resection combined with thermal ablation in sequential treatment of patients with multiple primary lung cancer (MPLC). Methods Patients with MPLC who underwent simultaneous, sequential surgical resection combined with thermal ablation at Shangjin Branch of West China Hospital of Sichuan University from 2023 to 2024 were retrospectively included, and their perioperative and follow-up data were analyzed. Results A total of 23 MPLC patients with a mean age of 51.61±12.38 years, 4 males and 19 females were included. Cumulatively, 48 lesions were resected and 23 lesions were ablated. About half of the patients (52.17%) had surgery and ablation treatment located in the same lung. All patients completed the combined treatment without intraoperative complications. Four patients had postoperative complications, and were effectively managed and successfully discharged. The median postoperative hospital stay was 4.00 (4.00, 4.00) days. The median follow-up duration was 11.78 ± 4.90 months, with a local control rate (LCR) of 100.00% at 6 months postoperatively. No deaths or tumor occurred during follow-up. Conclusion Simultaneous surgery with thermal ablation in sequential treatment for MPLC is safe, flexible and effective, providing a new option for this group of patients, but further studies are needed to evaluate its long-term efficacy.

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2.	Dong H, Tian Y, Xin S, et al. Diagnosis and management of multiple primary lung cancer. Front Oncol, 2024, 14: 1392969.
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10.	中国医药教育协会肺癌医学教育委员会, 中国胸外科肺癌联盟, 中国抗癌协会肿瘤消融治疗专业委员会, 等. 多发磨玻璃结节样肺癌多学科诊疗中国专家共识(2024年版). 中华内科杂志, 2024, 63(2): 153-169.Lung Cancer Medical Education Committee of the Chinese Medical Education Association, Lung Cancer Alliance of Chinese Thoracic Surgery, Society of Tumor Ablation Therapy of the Chinese Anti-Cancer Association, Tumor Ablation Expert Committee of the Chinese Society of Clinical Oncology, Tumor Ablation Expert Group of the Chinese College of Interventionalists. Chinese expert consensus: multidisciplinary diagnosis and treatment of multiple ground-glass nodule like lung cancer (2024 edition). Chin J Intern Med, 2024, 63(2): 153-169.
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13.	Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg, 1975, 70(4): 606-612.
14.	Ye X, Fan W, Wang Z, et al. Expert consensus on thermal ablation therapy of pulmonary subsolid nodules (2021 Edition). J Cancer Res Ther, 2021, 17(5): 1141-1156.
15.	Bao F, Yu F, Wang R, et al. Electromagnetic bronchoscopy guided microwave ablation for early stage lung cancer presenting as ground glass nodule. Transl Lung Cancer Res, 2021, 10(9): 3759-3770.
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17.	Chan JWY, Lau RWH, Chang ATC, et al. Concomitant electromagnetic navigation transbronchial microwave ablation of multiple lung nodules is safe, time-saving, and cost-effective. JTCVS Techniques, 2023, 22: 265-272.
18.	Chang LK, Su PK, Chan PS, et al. Single-stage image-guided percutaneous ablation with thoracoscopic resection for multiple pulmonary lesions in a hybrid operating room: a retrospective study. Cancers, 2024, 16(20): 3512.
19.	Qu R, Tu D, Hu S, et al. Electromagnetic navigation bronchoscopy-guided microwave ablation combined with uniportal video-assisted thoracoscopic surgery for multiple ground glass opacities. Ann Thorac Surg, 2022, 113(4): 1307-1315.
20.	Wang S, Su C, Li J, et al. The use of electromagnetic navigation bronchoscopy-guided microwave ablation in patients with multiple bilateral pulmonary nodules: a retrospective study of 26 cases. J Thorac Dis, 2024, 16(10): 6347-6356.
21.	Jiang N, Zhang L, Hao Y, et al. Combination of electromagnetic navigation bronchoscopy-guided microwave ablation and thoracoscopic resection: an alternative for treatment of multiple pulmonary nodules. Thorac Cancer, 2020, 11(6): 1728-1733.
22.	Castiglioni M, Louie BE, Wilshire CL, et al. Patients with multiple nodules and a dominant lung adenocarcinoma have similar outcomes and survival compared with patients who have a solitary adenocarcinoma. Interact Cardiovasc Thorac Surg, 2015, 20(2): 229-235.
23.	Hotta T, Tsubata Y, Tanino A, et al. Comparative postoperative outcomes of GGN-dominant vs single lesion lung adenocarcinomas. J Cardiothorac Surg, 2020, 15(1): 149.
24.	Kim TJ, Goo JM, Lee KW, et al. Clinical, pathological and thin-section CT features of persistent multiple ground-glass opacity nodules: comparison with solitary ground-glass opacity nodule. Lung Cancer, 2009, 64(2): 171-178.

1. Heuvelmans MA, Walter JE, Peters RB, et al. Relationship between nodule count and lung cancer probability in baseline CT lung cancer screening: the NELSON study. Lung Cancer, 2017, 113: 45-50.
2. Dong H, Tian Y, Xin S, et al. Diagnosis and management of multiple primary lung cancer. Front Oncol, 2024, 14: 1392969.
3. Viani GA, Gouveia AG, Yan M, et al. Stereotactic body radiotherapy versus surgery for early-stage non-small cell lung cancer: an updated meta-analysis involving 29, 511 patients included in comparative studies. J Bras Pneumol, 2022, 48(3): e20210390.
4. Cheng B, Li C, Zhao Y, et al. The impact of postoperative EGFR-TKIs treatment on residual GGO lesions after resection for lung cancer. STTT, 2021, 6(1): 73.
5. Xu L, Shi M, Wang S, et al. Immunotherapy for bilateral multiple ground glass opacities: an exploratory study for synchronous multiple primary lung cancer. Front Immunol, 2022, 13: 1009621.
6. Wang Z, Zhang Q, Wang C, et al. Multiple primary lung cancer: updates and perspectives. Intern J Cancer, 2024, 155(5): 785-799.
7. 中国临床肿瘤学会(CSCO)肿瘤消融治疗专家委员会, 中国医师协会肿瘤消融治疗技术专家组, 中国抗癌协会肿瘤消融治疗专业委员会, 等. 影像引导下热消融治疗原发性和转移性肺部肿瘤临床实践指南(2021年版). 中华内科杂志, 2021, 60(12): 1088-1105.Ablation Expert Committee of the Chinese Society of Clinical Oncology, Expert Group on Tumor Ablation Therapy of the Chinese Medical Doctors Association, Society of Tumor Ablation Therapy of the Chinese Anti-Cancer Association, Tumor Ablation Committee of the Chinese College of Interventionalists. Clinical practice guidelines: image-guided thermal ablation of primary and metastatic lung tumors (2021 edition). Chin J Intern Med, 2021, 60(12): 1088-1105.
8. Murphy MC, Wrobel MM, Fisher DA, et al. Update on image-guided thermal lung ablation: society guidelines, therapeutic alternatives, and postablation imaging findings. AJR Am J Roentgenol, 2022, 219(3): 471-485.
9. Nezami N, Khorshidi F, Mansur A, et al. Primary and metastatic lung cancer: rationale, indications, and outcomes of thermal ablation. Clin Lung Cancer, 2023, 24(5): 389-400.
10. 中国医药教育协会肺癌医学教育委员会, 中国胸外科肺癌联盟, 中国抗癌协会肿瘤消融治疗专业委员会, 等. 多发磨玻璃结节样肺癌多学科诊疗中国专家共识(2024年版). 中华内科杂志, 2024, 63(2): 153-169.Lung Cancer Medical Education Committee of the Chinese Medical Education Association, Lung Cancer Alliance of Chinese Thoracic Surgery, Society of Tumor Ablation Therapy of the Chinese Anti-Cancer Association, Tumor Ablation Expert Committee of the Chinese Society of Clinical Oncology, Tumor Ablation Expert Group of the Chinese College of Interventionalists. Chinese expert consensus: multidisciplinary diagnosis and treatment of multiple ground-glass nodule like lung cancer (2024 edition). Chin J Intern Med, 2024, 63(2): 153-169.
11. Riely GJ, Wood DE, Ettinger DS, et al. Non-small cell lung cancer, Version 4. 2024, NCCN Clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2024, 22(4): 249-274.
12. von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet, 2007, 370(9596): 1453-1457.
13. Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg, 1975, 70(4): 606-612.
14. Ye X, Fan W, Wang Z, et al. Expert consensus on thermal ablation therapy of pulmonary subsolid nodules (2021 Edition). J Cancer Res Ther, 2021, 17(5): 1141-1156.
15. Bao F, Yu F, Wang R, et al. Electromagnetic bronchoscopy guided microwave ablation for early stage lung cancer presenting as ground glass nodule. Transl Lung Cancer Res, 2021, 10(9): 3759-3770.
16. Bartlett EC, Rahman S, Ridge CA. Percutaneous image-guided thermal ablation of lung cancer: What is the evidence? Lung Cancer, 2023, 176: 14-23.
17. Chan JWY, Lau RWH, Chang ATC, et al. Concomitant electromagnetic navigation transbronchial microwave ablation of multiple lung nodules is safe, time-saving, and cost-effective. JTCVS Techniques, 2023, 22: 265-272.
18. Chang LK, Su PK, Chan PS, et al. Single-stage image-guided percutaneous ablation with thoracoscopic resection for multiple pulmonary lesions in a hybrid operating room: a retrospective study. Cancers, 2024, 16(20): 3512.
19. Qu R, Tu D, Hu S, et al. Electromagnetic navigation bronchoscopy-guided microwave ablation combined with uniportal video-assisted thoracoscopic surgery for multiple ground glass opacities. Ann Thorac Surg, 2022, 113(4): 1307-1315.
20. Wang S, Su C, Li J, et al. The use of electromagnetic navigation bronchoscopy-guided microwave ablation in patients with multiple bilateral pulmonary nodules: a retrospective study of 26 cases. J Thorac Dis, 2024, 16(10): 6347-6356.
21. Jiang N, Zhang L, Hao Y, et al. Combination of electromagnetic navigation bronchoscopy-guided microwave ablation and thoracoscopic resection: an alternative for treatment of multiple pulmonary nodules. Thorac Cancer, 2020, 11(6): 1728-1733.
22. Castiglioni M, Louie BE, Wilshire CL, et al. Patients with multiple nodules and a dominant lung adenocarcinoma have similar outcomes and survival compared with patients who have a solitary adenocarcinoma. Interact Cardiovasc Thorac Surg, 2015, 20(2): 229-235.
23. Hotta T, Tsubata Y, Tanino A, et al. Comparative postoperative outcomes of GGN-dominant vs single lesion lung adenocarcinomas. J Cardiothorac Surg, 2020, 15(1): 149.
24. Kim TJ, Goo JM, Lee KW, et al. Clinical, pathological and thin-section CT features of persistent multiple ground-glass opacity nodules: comparison with solitary ground-glass opacity nodule. Lung Cancer, 2009, 64(2): 171-178.

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