Cryoablation versus thoracoscopic resection in the local management of pulmonary metastatic lesions: a single-center comparative study

Background Surgical resection remains a commonly used local treatment option for selected patients with pulmonary metastases. However, reoperation may be technically difficult after prior ipsilateral thoracic surgery or when substantial pleural adhesions are anticipated. Percutaneous cryoablation (CA) is a parenchyma-sparing local treatment option. This study compared short-term perioperative outcomes between CA and thoracoscopic resection; it was not designed to establish oncologic equivalence. Methods We retrospectively analyzed 85 patients with metastatic pulmonary tumors treated at a single tertiary center between June 2022 and September 2024. The patients underwent thoracoscopic pulmonary metastasectomy ( n = 70) or percutaneous cryoablation ( n = 15). Short-term perioperative parameters, including prosedure time, chest drainage, length of hospital stay, and procedure-related cost, were compared between the groups. Results Prior ipsilateral pulmonary resection was more frequent in the CA group (66.7% vs. 17.1%; P < 0.001). Mean procedure time was longer with CA (4.68 vs. 2.71 h; P < 0.001), whereas post procedure length of stay was similar ( P = 0.206). Management without thoracic drainage was more frequent after CA (46.7% vs. 2.9%; P < 0.001), and the number and maximum size of drains were lower ( P = 0.008 and P < 0.001, respectively). Median procedure-related cost was higher for CA in our reimbursement setting (191,000 [IQR, 150,000–252,500] vs. 44,251 [IQR, 34,565–63,623] New Taiwan dollars; P < 0.001). Conclusions In this small, clinically selected cohort, CA was associated with a lower drainage burden but higher cost. These exploratory perioperative findings do not establish oncologic equivalence. CA may be considered when repeat thoracoscopic resection is difficult or undesirable, provided that it is performed at an experienced center with immediate thoracic surgical support.