Extending indications for radiofrequency ablation of lung tumors through an intraoperative approach

Radiofrequency ablation (RFA) is a means of local destruction of lung tumors. The role of this technique in regards to improved survival or quality of life has yet to be well defined. RFA can be performed through an intraoperative or percutaneous route. Percutaneous RFA can be performed without single-lung ventilation under local anesthesia with sedation and is often the preferred route of ablation. We detail instances of RFA in patients who were either not candidates for percutaneous RFA or in whom the tumor was found to be unresectable at operation.

Ten patients with either primary or secondary lung tumors who underwent operation with consideration of intraoperative RFA were reviewed. Patients were followed up with chest computed tomography scans at least every 6 months. Preoperative characteristics, intraoperative techniques, complications, and tumor response were noted.

The median patient age was 60 years (range, 40 to 85 years). Six patients had lung cancer, 4 had cancer metastatic to the lung, and 5 patients had hilar lesions. Combined lung resection and RFA was done in 4 patients; 6 underwent RFA only. The average size of the ablated lesion was 3.0 cm (range, 1.0 to 5.8 cm). No serious intraoperative or perioperative complications were noted. No immediate or delayed hemorrhage or hemoptysis has been noted. Of patients at least 6 months out from ablation, 4 had no growth of the ablated tumor at an average of 13.5 months (range, 8 to 23 months) after ablation, and 5 have had growth of the tumor first noted at an average of 12.8 months (range, 9 to 14) after ablation.

Intraoperative RFA is useful (1) when the lesion is near vital structures such as the great vessels, hilum, or heart, (2) if resectability can only be determined at the time of operation, and (3) when used in patients with secondary tumors of the lung combined with limited resection to preserve lung parenchyma.