Risk Factors for Pneumothorax Complicating Radiofrequency Ablation for Lung Malignancy: A Systematic Review and Meta-Analysis

Abstract

PurposeTo assess the potential risk factors for pneumothorax secondary to pulmonary radiofrequency (RF) ablation. Materials and MethodsSix electronic databases were searched from inception to February 2014 for studies assessing potential patient-related, tumor-related, or treatment-related risk factors for pneumothorax during pulmonary RF ablation. Study selection, data collection, and quality assessment were done by three independent reviewers. ResultsAmong 771 studies identified in the search, 10 retrospective cohort studies met inclusion criteria. There were 981 patients (61.5% male) with a mean age of 64.2 years included (259 primary lung tumors, 722 metastatic tumors). The prevalence of pneumothorax was 37% (95% confidence interval [CI], 29%–46%) in 1,916 RF ablation sessions. The potential patient-related and tumor-related risk factors for pneumothorax were increased age (mean difference [MD], 2.09; 95% CI [0.11–4.06]; I2 = 0%), male gender (unadjusted odds ratio [OR], 2.20; 95% CI [1.49-3.27]; I2 = 0%), no history of lung surgery (unadjusted OR, 0.29; 95% CI [0.19–0.44]; I2 = 0%), and a greater number of tumors ablated (MD, 0.50; 95% CI [0.27–0.73]; I2 = 0%). ConclusionBased on available observational studies, the results suggest risk factors for pneumothorax secondary to pulmonary RF ablation may include increased age, male gender, no history of lung surgery, number of tumors ablated, and increased length of the aerated lung traversed by the electrode. The findings from this systematic review should be interpreted with caution because of the inherent limitations of the retrospective observational design.