Effectiveness of Track Cauterization in Reduction of Adverse Events for Lung Microwave Ablation

Abstract

Purpose: To evaluate the effectiveness of track cautery for lung microwave ablation (MWA) to reduce postprocedural adverse events (AE).

Materials and methods: Patients who underwent percutaneous lung MWA between 2012 and 2021 were divided into 2 cohorts: patients in whom track cautery was conducted during antenna removal and patients in whom the antenna was simply removed. Patient demographics, treatment history, tumor characteristics, and ablation details were collected. Postprocedural AEs including immediate, enlarging, and delayed pneumothorax (PTX), pleural effusion, and reinterventions were recorded. Univariate and multivariate logistic regression models were used to identify factors associated with AEs.

Results: This study included 365 lung MWA sessions for 190 patients. Of the 165 patients in the cautery cohort, 78 (47%) had immediate PTX, 16 (10%) had enlarging PTX, 2 (1%) had delayed PTX, and 15 (9%) needed interventions. Of the 200 patients in the noncautery cohort, 85 (43%) had immediate PTX, 45 (23%) had enlarging PTX, 16 (8%) had delayed PTX, and 37 (19%) needed interventions. The cautery cohort had significantly reduced rates of enlarging PTX (odds ratio [OR], 0.67; 95% CI, 0.34-1.33; P = .002), delayed PTX (OR, 0.15; 95% CI, 0.03-0.89; P = .037), and pleural effusion (OR, 0.38; 95% CI, 0.15-0.99; P = .049). The presence of emphysema, large tumor size, and left lower lobe location were shown to be significant predictors of AEs and the need for interventions (P < .05).

Conclusions: Track cauterization is associated with reduction of post-MWA enlarging PTX, delayed PTX, and pleural effusion. Presence of emphysema, lack of track cautery, large tumor size, and tumors in the left lower lobe were shown to be predictors of postprocedural AEs.