Abstract
Purpose
The purpose of this study was to evaluate altered pulmonary function retrospectively after RFA.
Methods
This retrospective study comprised 41 ablation sessions for 39 patients (22 men and 17 women; mean age, 64.8 years). Vital capacity (VC) and forced expiratory volume in 1 s (FEV1) at 1 and 3 months after RFA were compared with the baseline (i.e., values before RFA). To evaluate the factors that influenced impaired pulmonary function, univariate analysis was performed by using multiple variables. If two or more variables were indicated as statistically significant by univariate analysis, these variables were subjected to multivariate analysis to identify independent factors.
Results
The mean VC and FEV1 before RFA and 1 and 3 months after RFA were 3.04 and 2.24 l, 2.79 and 2.11 l, and 2.85 and 2.13 l, respectively. The values at 1 and 3 months were significantly lower than the baseline. Severe pleuritis after RFA was identified as the independent factor influencing impaired VC at 1 month (P = 0.003). For impaired FEV1 at 1 month, only severe pleuritis (P = 0.01) was statistically significant by univariate analysis. At 3 months, severe pleuritis (VC, P = 0.019; FEV1, P = 0.003) and an ablated parenchymal volume ≥20 cm3 (VC, P = 0.047; FEV1, P = 0.038) were independent factors for impaired VC and FEV1.
Conclusions
Pulmonary function decreased after RFA. RFA-induced severe pleuritis and ablation of a large volume of marginal parenchyma were associated with impaired pulmonary function.
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Appendix
Appendix
Severe pleuritis and larger ablated parenchymal volume were the variables that were obtained after RFA. Thus, regrettably, those were not quite helpful in predicting impaired pulmonary function in advance. Then, additional analysis was performed to evaluate the predictive factors for the occurrence of severe pleuritis and larger ablated parenchymal volume. Univariate analysis with chi-square test or Fisher’s exact tests was performed by using multiple variables that were available before RFA, including age, sex, pulmonary emphysema, pre-RFA %VC, pre-RFA FEV1%, tumor type, distance to the nearest pleura from tumors, tumor volume, and electrode type. The results are shown in Table 5.
Although there was no variable significantly increasing a risk of severe pleuritis, pulmonary emphysema had a tendency (P = 0.052) to be associated with the occurrence of severe pleuritis after RFA. The variables that increased a risk of larger ablated parenchymal volume significantly were emphysema (P = 0.029) and tumor volume ≥1.3 cm3 (P = 0.011). Given that ventilation and perfusion has heat sink effect, decreased ventilation and perfusion in the emphysematous lung may explain the association between pulmonary emphysema and more extensive ablation leading to severe pleuritis and larger ablated parenchymal volume.
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Tada, A., Hiraki, T., Iguchi, T. et al. Influence of Radiofrequency Ablation of Lung Cancer on Pulmonary Function. Cardiovasc Intervent Radiol 35, 860–867 (2012). https://doi.org/10.1007/s00270-011-0221-z
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DOI: https://doi.org/10.1007/s00270-011-0221-z