Percutaneous radiofrequency ablation of pulmonary tumors—Is there a difference between treatment under general anaesthesia and under conscious sedation?

Abstract

Objective

This retrospective study aimed to compare feasibility, complication rate and local tumor control after radiofrequency ablation (RFA) of pulmonary tumors under conscious analgo-sedation (AS) versus general anaesthesia (GA).

Materials and methods

Within 36 months 21 patients had RFA (36 tumors, 26 treatment sessions). One patient suffered from NSCLC, 20 had metastases (breast (8/20), colorectal (6/20), renal cell (2/20), pharyngeal carcinoma (1/20), malignant melanoma (3/20)). Patients were no surgical candidates due to underlying comorbidities. Eleven of 26 treatments were performed under GA, while in 15 of 26 treatments AS was used. Follow-up was scheduled 24 h, 6 weeks, 3 months, 6 months and then every 6 months after treatment.

Results

RFA was feasible in all treatments under GA, while under AS targeting of the lesion was not possible in 2/15. Six adverse events occurred in the GA group (three major, three minor), while seven complications happened in the AS group (three major, four minor) (p = 0.57). During follow-up of 3–36 months local recurrence was detected in 3 of 21 tumors in the GA group and in 2 of 15 tumors in the AS group (p = 0.79).

Discussion

Hospitalization, complication rates and types, and the rate of local tumor control did not differ substantially among both groups. Furthermore, there was no significant difference in technical success and feasibility.

Conclusion

RFA of pulmonary tumors under GA or AS did not result in different tumor control and complication rates, respectively. Therefore, AS should be used except in anxious or agitated patients.

Introduction

Primary lung cancer is one of the most common malignancies and represents one of the most common cancer-related deaths in Europe—causing more deaths than both breast, colorectal and prostate cancer together. Additionally, the lungs are the second most frequent site of metastases from extra-pulmonary cancer and may represent the only site of distant metastases [1]. Until recently, treatment options (depending on tumor stage, local extension and patients comorbidities) included a combination of surgery, chemotherapy and/or radiation therapy. Surgery in primary lung tumors is regarded as the treatment of choice, if patients suffer from localized disease, but only up to 25% of tumors are regarded as resectable with curative intention [2]. Furthermore, it has been shown, that even in pulmonary metastases of colorectal cancer, melanoma, renal cell carcinoma and some other tumors resection improves patients survival compared to medical treatment alone [3]. However, open thoracic surgery is a very invasive procedure with considerable morbidity and mortality. Moreover, it requires general anaesthesia and a prolonged hospital stay [4]. Especially older patients suffering from other diseases (e.g. cardiac and cardiopulmonary diseases) are often not suitable candidates for surgery. Possible alternative, less invasive and lung-sparing therapeutical options for these patients include video-assisted thoracoscopy (VATS) and minimal-invasive, local ablative techniques like cryoablation, laser ablation, microwave- and radiofrequency ablation [5], [6], [7]. At present, radiofrequency ablation is the most frequently used thermal ablative technique. Especially percutaneous in situ ablation of primary and secondary lung lesions using radiofrequency ablation is an evolving minimally invasive therapy.

There are different opinions regarding the type of sedation of the patients during therapy, and some groups prefer general anaesthesia [8], while others advocate analgo-sedation [5], [9]. Due to the distinct movements of the lungs during in- and expiration the targeting of the tumor using a percutaneous access for the RF-probes is sometimes quite difficult, especially in patients unable to cooperate properly or in patients unable to hold their breath long enough to enable the interventional radiologist to target the lesion. Therefore, general anaesthesia is regarded as very useful. Double-lumen endotracheal tubes make it possible to have a “breath-hold” of the treated lung for a longer period during hyperoxigenation, while the other lung is still ventilated. In addition, the anaesthesiologist has to take care for the patients vital signs and monitoring, while the interventional radiologist is able to concentrate only on the therapeutic procedure. General anaesthesia, on the other hand, is associated with higher costs, a longer hospital stay and the anaesthesiology team may not be available when needed. Therefore the purpose of our retrospective study was to evaluate the safetiness regarding procedure-related complications, the duration of hospitalization and the local tumor control rate after percutaneous RFA using general anaesthesia versus the use of conscious analgo-sedation.