Single-center experience in combined video-assisted thoracic surgery with transbronchial microwave ablation—a novel approach to multifocal lung nodules

Background The management of multifocal lung malignancies presents significant challenges, particularly when extensive resection may not be feasible due to limited pulmonary reserve. Thus, a hybrid management approach combining lung surgery with transbronchial local ablation has been developed to control local disease while minimizing lung parenchymal loss. We evaluated the safety, feasibility, and mid-term clinical outcomes of this hybrid approach in managing multifocal lung lesions. Methods A retrospective single-center review was conducted of patients who underwent combined video-assisted thoracic surgery (VATS) lung resection and transbronchial microwave ablation (TMWA) in a hybrid operating room (HOR) between November 2019 and April 2026. Patient demographics, tumor characteristics, procedural details, perioperative complications, and mid-term clinical outcomes were reported, including intraoperative technical success, 30-day morbidity, overall survival, and rate of local recurrence. Results Twenty-two patients (mean age 56.8 ± 11.8 years) with multifocal lung malignancies or suspicious multifocal lung nodules were discussed at a multidisciplinary team meeting. All twenty-two patients underwent 23 combined procedures. A total of 70 lesions were treated: 41 by VATS resection and 29 by TMWA. Technical success was achieved in 100% of procedures, as confirmed by intraoperative cone-beam computed tomography. The 30-day complication rate was 21.7%, with no procedure-related 30-day mortality. 20 patients have follow-up beyond 30 days (two patients were lost to follow-up). At a median follow-up of 24 months, the local control rate for ablated lesions was 96.6%, with local-recurrence-free survival of 95% and overall survival of 85%. Among the 41 resected lung lesions, 17 were multifocal lung adenocarcinoma, 22 were metastatic nodules, and two showed no evidence of malignancy. However, preoperative histopathological confirmation was available for only four ablated lesions, which showed either atypical pneumocytes or lung adenocarcinoma. Conclusions Hybrid treatment combining VATS and TMWA is a safe and feasible approach for multifocal lung lesions, with reasonable complication rates and acceptable mid-term disease control. This hybrid technique may offer benefits in parenchymal preservation, particularly in patients with borderline lung function, while achieving reasonable local control.