Surgical approach to microwave and radiofrequency liver ablation for hepatocellular carcinoma and colorectal liver metastases less than 5 cm: a systematic review and meta-analysis

Moustafa Abdalla; Amelia T Collings; Rebecca Dirks; Edwin Onkendi; Daniel Nelson; Ahmad Ozair; Emily Miraflor; Faique Rahman; Jake Whiteside; Mihir M Shah; Subhashini Ayloo; Ahmed Abou-Setta; Iswanto Sucandy; Ali Kchaou; Samuel Douglas; Patricio Polanco; Timothy Vreeland; Joseph Buell; Mohammed T Ansari; Aurora D Pryor; Bethany J Slater; Ziad Awad; William Richardson; Adnan Alseidi; D Rohan Jeyarajah; Eugene Ceppa

doi:10.1007/s00464-022-09815-5

Surgical approach to microwave and radiofrequency liver ablation for hepatocellular carcinoma and colorectal liver metastases less than 5 cm: a systematic review and meta-analysis

Surg Endosc. 2023 May;37(5):3340-3353. doi: 10.1007/s00464-022-09815-5. Epub 2022 Dec 21.

Authors

Moustafa Abdalla¹, Amelia T Collings², Rebecca Dirks², Edwin Onkendi³, Daniel Nelson⁴, Ahmad Ozair⁵, Emily Miraflor⁶, Faique Rahman⁷, Jake Whiteside², Mihir M Shah⁸, Subhashini Ayloo⁹, Ahmed Abou-Setta¹⁰, Iswanto Sucandy¹¹, Ali Kchaou¹², Samuel Douglas¹³, Patricio Polanco¹⁴, Timothy Vreeland¹⁵, Joseph Buell¹⁶, Mohammed T Ansari¹⁷, Aurora D Pryor¹⁸, Bethany J Slater¹⁹, Ziad Awad²⁰, William Richardson²¹, Adnan Alseidi²², D Rohan Jeyarajah²³, Eugene Ceppa²⁴

Affiliations

¹ Department of Surgery, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA.
² Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA.
³ Department of Surgery, Texas Tech University Health Sciences, Lubbock, TX, USA.
⁴ Department of Surgery, William Beaumont Army Medical Center, Fort Bliss, TX, USA.
⁵ King George's Medical University, Chowk, Lucknow, India.
⁶ Department of Surgery, University of California, San Francisco - East Bay, CA, USA.
⁷ Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India.
⁸ Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA.
⁹ Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA.
¹⁰ Knowledge Synthesis, University of Manitoba, Winnipeg, MB, Canada.
¹¹ Department of Surgery, University of Central Florida, Tampa, FL, USA.
¹² Department of Surgery, University of Sfax, Sfax, Tunisia.
¹³ Sentara Medical Group, Norfolk, VA, USA.
¹⁴ University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁵ Department of Surgery, Brooke Army Medical Center, Houston, TX, USA.
¹⁶ Department of Surgery and Pediatrics, Tulane University, New Orleans, LA, USA.
¹⁷ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
¹⁸ Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
¹⁹ Department of Surgery, University of Chicago, Chicago, IL, USA.
²⁰ Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
²¹ Department of Surgery, Ochsner Clinic, New Orleans, LA, USA.
²² Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
²³ Department of Surgery, TCU and UNTHSC School of Medicine, Fort Worth, TX, USA.
²⁴ Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA. eceppa@iu.edu.

PMID: 36542137
DOI: 10.1007/s00464-022-09815-5

Abstract

Background: Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the two most common malignant neoplasms of the liver. The objective of this study was to assess outcomes of surgical approaches to liver ablation comparing laparoscopic versus percutaneous microwave ablation (MWA), and MWA versus radiofrequency ablation (RFA) in patients with HCC or CRLM lesions smaller than 5 cm.

Methods: A systematic review was conducted across seven databases, including PubMed, Embase, and Cochrane, to identify all comparative studies between 1937 and 2021. Two independent reviewers screened for eligibility, extracted data for selected studies, and assessed study bias using the modified Newcastle Ottawa Scale. Random effects meta-analyses were subsequently performed on all available comparative data.

Results: From 1066 records screened, 11 studies were deemed relevant to the study and warranted inclusion. Eight of the 11 studies were at high or uncertain risk for bias. Our meta-analyses of two studies revealed that laparoscopic MW ablation had significantly higher complication rates compared to a percutaneous approach (risk ratio = 4.66; 95% confidence interval = [1.23, 17.22]), but otherwise similar incomplete ablation rates, local recurrence, and oncologic outcomes. The remaining nine studies demonstrated similar efficacy of MWA and RFA, as measured by incomplete ablation, complication rates, local/regional recurrence, and oncologic outcomes, for both HCC and CRLM lesions less than 5 cm (p > 0.05 for all outcomes). There was no statistical subgroup interaction in the analysis of tumors < 3 cm.

Conclusion: The available comparative evidence regarding both laparoscopic versus percutaneous MWA and MWA versus RFA is limited, evident by the few studies that suffer from high/uncertain risk of bias. Additional high-quality randomized trials or statistically matched cohort studies with sufficient granularity of patient variables, institutional experience, and physician specialty/training will be useful in informing clinical decision making for the ablative treatment of HCC or CRLM.

Keywords: Colorectal liver metastases; Hepatocellular carcinoma; Laparoscopic; Microwave ablation; Percutaneous; Radiofrequency ablation.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Carcinoma, Hepatocellular* / pathology
Carcinoma, Hepatocellular* / surgery
Catheter Ablation*
Colorectal Neoplasms* / surgery
Humans
Liver Neoplasms* / secondary
Microwaves / therapeutic use
Radiofrequency Ablation*
Treatment Outcome