Microwave ablation for residual ground-glass nodule-like lung cancer after video-assisted thoracoscopic surgery: a retrospective, large-sample, multicenter study.

Introduction: The management of residual or new ground-glass nodule (GGN)-like lung cancer after video-assisted thoracoscopic surgery (VATS) is challenging for patients who are not suitable for reoperation. This retrospective, large-sample, multicenter study aimed to evaluate the feasibility, safety, and preliminary efficacy of microwave ablation (MWA) for residual GGN-like lung cancer after VATS in early-stage lung cancer.

Methods: A total of 216 patients with 216 residual GGN-like lung cancers who underwent 235 procedures of CT-guided percutaneous MWA after VATS (R0) of stage I-IIA lung adenocarcinoma from July 2016 to December 2023 were included in the study. The primary endpoints were technical success, complications, and pulmonary function test (PFT) variations after the MWA procedure. The secondary endpoints were local progression-free survival (LPFS) and overall survival (OS).

Results: The rate of technical success was 100%. The major complications after MWA included pneumothorax (12.3%, 29/235), pleural effusion (5.5%, 13/235), pulmonary infection (2.6%, 6/235), hydropneumothorax (1.3%, 3/235), intrathoracic hemorrhage (0.4%, 1/235), and bronchopleural fistula (0.4%, 1/235). No MWA procedure-related death was observed. The PFT at 1-3 months after MWA was not significantly different from the baseline. The median follow-up duration was 58.5 months, and the 1-, 3- and 5-year OS rates were 100%, 99.1% and 96.3%, respectively. The median follow-up period after MWA was 33.8 months, and the 1-, 2- and 3-year LPFS rates were 100%, 97.7% and 96.3%, respectively.

Conclusions: CT-guided percutaneous MWA is a safe, effective, and potentially curative approach for patients with residual GGN-like lung cancer after VATS.