Ann Thorac Surg 2009;88:351-352. doi:10.1016/j.athoracsur.2009.01.005
© 2009 The Society of Thoracic Surgeons
Correspondence
Is a 1-cm Margin From Major Vessels Adequate for Radiofrequency Ablation of Pulmonary Neoplasms?
Antonio Basile, MDa,
Giuseppe Banna, MDb,
Salvatore Saita, MDc,
Francesco Coppolino, MDd,
Maria Teresa Patti, MDa
a Department of Diagnostic and Interventional Radiology, Ospedale Ferrarotto, Via Citelli 6, Catania, 95124 Italy
b Department of Oncology, Ospedale Vittorio Emanuele, Via Plebiscito 125, Catania, 95124 Italy
c Department of Thoracic Surgery, Ospedale Vittorio Emanuele, Via Plebiscito 125, Catania, 95124 Italy
d Department of Radiology, Policlinico Paolo Giaccone, University of Palermo, Palermo, 90127 Italy
(Email: antodoc{at}yahoo.com).
To the Editor:
We read with interest the article of Dr Fernando [1], who reviewed the "state of the art" for radiofrequency ablation (RFA) of primary or secondary lung cancer [1]. We particularly appreciated the suggestion to limit lung RFA to the outer two-thirds of the lung parenchyma to avoid proximity to the hilar blood vessels.
Recently an animal study [2] pathologically confirmed that "RFA is effective with an acceptable degree of minimal damage to the normal lung tissue, and can be safely done near the pulmonary vessels." Another study [3] suggests that a 1-cm margin from major blood vessels is safe for RF ablation, as is currently used for RFA in solid organs.
We stress that the compressibility of lung parenchyma is a unique characteristic; therefore, a 1-cm margin may be inadequate in some cases. We illustrate the problem in the figure and legend as follows (Fig 1).
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Fig 1. (A) A 66-year-old woman had a pulmonary metastasis from rectal carcinoma, which appeared approximately 1.6 cm away from the large hilar blood vessels. (B) However, insertion of the electrode, following the long axis of the lesion in order to obtain total ablation, compressed the lung parenchyma against a major blood vessel. Fortunately, the patient did not have a complication.
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Recently an alert was issued by the United States Food and Drug Administration on mortality observed with the use of RFA for lung lesions [4]s. Thus, the compressibility of the lung must be considered in planning and executing RFA of lung lesions near major vessels.
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References
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- Fernando HC. Radiofrequency ablation to treat non-small cell lung cancer and pulmonary metastases Ann Thorac Surg 2008;85:S780-S784.[Abstract/Free Full Text]
- Ogawa E, Fukuse T, Toda Y, Kotani Y, Wada H, Manabe T. Effects and risks of radiofrequency ablation on the pulmonary tissue and vascular system: a preliminary histological study Surg Today 2008;38:425-431.[Medline]
- Lencioni R, Crocetti L, Cioni R, et al. Radiofrequency ablation of lung malignancies: where do we stand? Cardiovasc Intervent Radiol 2004;27:581-590.[Medline]
- FDA public health notification: deaths reported following radio frequency ablation of lung tumors. Publication date: December 11, 2007http://www.fda.gov/cdrh/safety/121107-rfablation.html 2004Accessed December 21, 2007.
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