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.
Similar content being viewed by others
References
Abdalla EK, Vauthey J-N, Ellis LM, Ellis V, Pollock R, Broglio KR, Hess K, Curley SA (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239:818–825
Bhardwaj N, Strickland A, Ahmad F, Dennison A, Lloyd D (2010) Liver ablation techniques: a review. Surg Endosc 24:254–265
McGhana JP, Dodd GD III (2001) Radiofrequency ablation of the liver: current status. AJR Am J Roentgenol 176:3–16
Decadt B, Siriwardena AK (2004) Radiofrequency ablation of liver tumours: systematic review. Lancet Oncol 5:550–560
European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943
Benson AB 3rd, Abrams TA, Ben-Josef E, Bloomston PM, Botha JF, Clary BM, Covey A, Curley SA, D’Angelica MI, Ensminger DR, WD, Gibbs JF, Laheru D, Malafa MP, Marrero J, Meranze SG, Mulvihill SJ, Park JO, Posey JA, Sachdev J, Salem R, Sigurdson ER, Sofocleous C, Vauthey JN, Venook AP, Goff LW, Yen Y, Zhu AX, (2009) NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Canc Netw 7:350–391
Rich NE, Yopp AC, Singal AG, Murphy CC (2020) Hepatocellular carcinoma incidence is decreasing among younger adults in the United States. Clin Gastroenterol Hepatol 18:242-248e5
Siegel RL, Fedewa SA, Anderson WF, Miller KD, Ma J, Rosenberg PS, Jemal A (2017) Colorectal cancer incidence patterns in the United States 1974–2013. J Natl Cancer Inst 109:322
International Agency for Research on Cancer 2012 GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012 https://gco.iarc.fr/
Martin J, Petrillo A, Smyth EC, Shaida N, Khwaja S, Cheow H, Duckworth A, Mahvi H, blative Therapies for Hepatic Neoplasmster P, Praseedom R, Jah A, (2020) Colorectal liver metastases: current management and future perspectives. World J Clin Oncol 11:761–808
Wells SA, Hinshaw JL, Lubner MG, Ziemlewicz TJ, Brace CL, Lee FT (2015) Liver ablation: best practice. Radiol Clin North Am 53:933–971
Izzo F, Granata V, Grassi R, Fusco R, Palaia R, Delrio P, Carrafiello G, Azoulay D, Petrillo A, Curley SA (2019) Radiofrequency ablation and microwave ablation in liver tumors: an update. Oncologist 24:e990–e1005
Mahvi DA, Mahvi DM (2019) Ablative therapies for hepatic neoplasms. In: Yeo (ed) Shackelford’s surgery of the alimentary tract, vol 2, 8th edn. Elsevier, Amsterdam, pp 1481–1487
Poulou LS, Botsa E, Thanou I, Ziakas PD, Thanos L (2015) Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol 7:1054–1063
Violi NV, Duran R, Guiu B, Cercueil J-P, Aubé C, Digklia A, Pache I, Deltenre P, Knebel J-F, Denys A (2018) Efficacy of microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma in patients with chronic liver disease: a randomised controlled phase 2 trial. Lancet Gastroenterol Hepatol 3:317–325
Sutherland LM, Williams JA, Padbury RT, Gotley DC, Stokes B, Maddern GJ (2006) Radiofrequency ablation of liver tumors: a systematic review. Arch Surg 141:181–190
Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, McKenzie JE (2021) PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 372:n160
Peterson J, Welch V, Losos M, Tugwell P (2011) The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa 2:1–12
Della Corte A, Ratti F, Monfardini L, Marra P, Gusmini S, Salvioni M, Venturini M, Cipriani F, Aldrighetti L, De Cobelli F (2020) Comparison between percutaneous and laparoscopic microwave ablation of hepatocellular carcinoma. Int J Hyperthermia 37:542–548
De Cobelli F, Marra P, Ratti F, Ambrosi A, Colombo M, Damascelli A, Sallemi C, Gusmini S, Salvioni M, Diana P, Cipriani F, Venturini M, Aldrighetti L, Del Maschio A (2017) Microwave ablation of liver malignancies: comparison of effects and early outcomes of percutaneous and intraoperative approaches with different liver conditions. Med Oncol 34:49
An C, Li W-Z, Huang Z-M, Yu X-L, Han Y-Z, Liu F-Y, Wu S-S, Yu J, Liang P, Huang J (2021) Small single perivascular hepatocellular carcinoma: comparisons of radiofrequency ablation and microwave ablation by using propensity score analysis. Eur Radiol 31:4764–4773
Correa-Gallego C, Fong Y, Gonen M, D’Angelica MI, Allen PJ, DeMatteo RP, Jarnagin WR, Kingham TP (2014) A retrospective comparison of microwave ablation vs. radiofrequency ablation for colorectal cancer hepatic metastases. Ann Surg Oncol 21:4278–4283
Lee K-f, Wong J, Hui JW-y, Cheung Y-s, Chong CC-n, Fong AK-w, Yu SC-h, Bo-san Lai P, (2017) Long-term outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma by surgical approach: a retrospective comparative study. Asian J Surg 40:301–308
Sakaguchi H, Seki S, Tsuji K, Teramoto K, Suzuki M, Kioka K, Isoda N, Ido K, Research JSfLT (2009) Endoscopic thermal ablation therapies for hepatocellular carcinoma: a multi-center study. Hepatol Res 39:47–52
Takahashi H, Kahramangil B, Kose E, Berber E (2018) A comparison of microwave thermosphere versus radiofrequency thermal ablation in the treatment of colorectal liver metastases. HPB (Oxford) 20:1157–1162
Yang B, Li Y (2017) A comparative study of laparoscopic microwave ablation with laparoscopic radiofrequency ablation for colorectal liver metastasis. J BUON 22:667–672
Simo KA, Sereika SE, Newton KN, Gerber DA (2011) Laparoscopic-assisted microwave ablation for hepatocellular carcinoma: safety and efficacy in comparison with radiofrequency ablation. J Surg Oncol 104:822–829
Santambrogio R, Chiang J, Barabino M, Meloni FM, Bertolini E, Melchiorre F, Opocher E (2017) Comparison of laparoscopic microwave to radiofrequency ablation of small hepatocellular carcinoma (≤ 3 cm). Ann Surg Oncol 24:257–263
Iida H, Aihara T, Ikuta S, Yamanaka N (2012) A comparative study of therapeutic effect between laparoscopic microwave coagulation and laparoscopic radiofrequency ablation. Hepatogastroenterology 60:662–665
Potretzke TA, Ziemlewicz TJ, Hinshaw JL, Lubner MG, Wells SA, Brace CL, Agarwal P, Lee FT Jr (2016) Microwave versus radiofrequency ablation treatment for hepatocellular carcinoma: a comparison of efficacy at a single center. J Vasc Interv Radiol 27:631–638
Xu Y, Shen Q, Wang N, Wu P-P, Huang B, Kuang M, Qian G-J (2017) Microwave ablation is as effective as radiofrequency ablation for very-early-stage hepatocellular carcinoma. Chin J Cancer 36:14
Liu W, Zheng Y, He W, Zou R, Qiu J, Shen J, Yang Z, Zhang Y, Wang C, Wang Y, Zuo D, Li B, Yuan Y (2018) Microwave vs radiofrequency ablation for hepatocellular carcinoma within the Milan criteria: a propensity score analysis. Aliment Pharmacol Ther 48:671–681
Glassberg MB, Ghosh S, Clymer JW, Qadeer RA, Ferko NC, Sadeghirad B, Wright GW, Amaral JF (2019) Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis. Onco Targets Ther 12:6407–6438
Facciorusso A, Di Maso M, Muscatiello N (2016) Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperthermia 32:339–344
Tan W, Deng Q, Lin S, Wang Y, Xu G (2019) Comparison of microwave ablation and radiofrequency ablation for hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperthermia 36:263–271
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
Aurora Pryor is a speaker for Ethicon, Gore, Medtronic, Merck, and Stryker. She has received research support from Obalon. Bethany Slater is a consultant for Bolder Surgical. 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, Ziad Awad, William Richardson, Adnan Alseidi, D. Rohan Jeyarajah, and Eugene Ceppa have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Abdalla, M., Collings, A.T., Dirks, R. et al. 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 37, 3340–3353 (2023). https://doi.org/10.1007/s00464-022-09815-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-022-09815-5