The role of microwave ablation in combination with surgery in the management of multiple high-risk pulmonary nodules.

Aim: To evaluate the feasibility and safety of surgical resection combined with microwave ablation (MWA) for patients with multiple high-risk pulmonary nodules.

Materials and methods: From September 2010 to November 2023, a total of 166 early multiple high-risk pulmonary nodule patients in our institution were retrospectively analyzed. Fifty-three patients who underwent surgical resection in combination with MWA were considered as the observation group, and 113 patients who underwent two operations or one operation to remove nodules in two lobes of the lungs were considered as the control group. The primary endpoint was postoperative progression-free survival (PFS). Secondary endpoints were lung function, postoperative complications, and length and cost of hospitalization.

Results: In the observation group, the median PFS was 37 months (1-63 months), 9 patients (16.98%) had postoperative recurrence, and the 1-year and 3-year PFS rates were 97.6% and 89.0%, respectively. In the control group, the median PFS was 36 months (1-56 months), 10 patients (8.84%) had postoperative recurrence, and the 1-year and 3-year PFS rates were 99% and 97.8%, respectively. The difference between the two groups was not statistically significant (P = 0.392). Lung function measurements showed a decrease in patients after surgery (P<0.05), and no significant change in patients after MWA (P > 0.05). Compared with two surgical resections, the combined treatment required less hospitalization and cost (P < 0.05).

Conclusion: For patients with multiple high-risk pulmonary nodules, surgical resection in combination with microwave ablation is an effective and safe treatment, which has less hospitalization and cost than using surgical resection alone.