Feasibility, safety and tolerability of thermal ablation in COPD patients with peripheral malignant pulmonary nodules

L. Yang*^a (Prof), Y. Hu^b (Dr), M. Ao^a (Dr)

^a Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, CHINA ; ^b Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, CHINA

* 315764964@qq.com

Background Currently, the feasibility, safety and tolerability of thermal ablation for COPD patients with peripheral malignant pulmonary nodules have not been reported.

Methods We prospectively collected the data from consecutive inoperability inpatient with highly suspected or confirmed malignant peripheral pulmonary nodules who underwent CT-guided therapeutic thermal ablation in our hospital from January 1st, 2019 to May 31^th, 2022. They were divided into COPD group and non-COPD group. Depending on whether the patient was diagnosed with malignant pulmonary nodules at baseline, thermal ablation directly alone or simultaneous percutaneous lung biopsy and thermal ablation were performed, respectively. The incidence, severity and risk factors of complications, changes in MMRC score, discharge time and hospitalization expenses in two groups were compared.

Results 194 patients were prospectively enrolled in this study with 67 in the COPD group and 127 in the non-COPD group. The total incidence of pneumothorax after procedures was significantly higher in the COPD group (32.84%) than in the non-COPD group (15.75%, p<0.05), but the severity of pneumothorax was mainly mild and there was no significantly difference in treatment for pneumothorax (p>0.05). COPD and / or pulmonary bullae was an independent high-risk factor for pneumothorax after procedures (OR=3.742, p<0.05). The incidence of pneumothorax between I-II(30.77%) with III-IV(60%) or A-B(30.77%) with C-D(60%) degree lung function did not reach the significant difference(p> 0.05). In the COPD group, the MMRC score was significantly increased at post-procedures than at the baseline(p<0.05), but there was no significantly difference in discharge time after procedures and hospitalization expenses between patients with or without pneumothorax (p>0.05).

Conclusions Although the incidence of pneumothorax and AECOPD after CT-guided thermal ablation was increased in inoperable high-risk COPD patients with peripheral malignant pulmonary nodules, there was no significantly difference in treatment and economic burden, and it is feasible, safe, and well tolerated.

Disclosure of funding source(s):

Chongqing Science and Technology Commission, Chongqing People’s Municipal Goverment (cstc2019jscx-msxmX0184), Discipline Innovation Fund of discipline Cultivation project from the First Affiliated Hospital of Chongqing Medical University (XKST134)  and Program for Youth Innovation in Future Medicine, Chongqing Medical University supported for the conduct of the study and had no such involvement.