Feasibility, safety and tolerability of CT-guided percutaneous thermal ablation in COPD with malignant pulmonary nodules

For early-stage non-small cell lung cancer, surgical resection was used as first treatment. However, approximately 20% of patients were not suitable for surgery due to the severe comorbidities. We verified the feasibility, safety and tolerability of percutaneous thermal ablation for patients of chronic obstructive pulmonary disease (COPD) with peripheral high-risk pulmonary nodules in real world. The ineligible or unwilling for surgery patients with peripheral high-risk pulmonary nodules who underwent CT-guided thermal ablation in our hospital from January 1st, 2019 to May 31th, 2022 were retrospectively collected, and divided into COPD and non COPD group. Incidence, severity, risk factors of complications between in different severity of COPD and non-COPD group were compared. A total of 216 high-risk patients were enrolled, including 73 in COPD group and 143 in non-COPD group. The average age, male gender, MMRC score, size of nodules, the incidence of confirmed pathological diagnosis and pneumothorax after thermal ablation were higher in COPD group than in non-COPD group. COPD was the only independent risk factor for pneumothorax after ablation. The incidence of pneumothorax increased with the severity of COPD, but no statistical significance. Compared to baseline, the MMRC score was significantly increased in COPD group, but there was no significant difference in the discharge time and hospitalization expenses between the COPD patients with or without pneumothorax. CT-guided percutaneous thermal ablation is a safe and feasible therapy for different severities COPD with high-risk pulmonary nodules, and it is well-tolerated without increasing medical burden.