Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. 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

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bhardwaj N, Strickland A, Ahmad F, Dennison A, Lloyd D (2010) Liver ablation techniques: a review. Surg Endosc 24:254–265

    Article  CAS  PubMed  Google Scholar 

  3. McGhana JP, Dodd GD III (2001) Radiofrequency ablation of the liver: current status. AJR Am J Roentgenol 176:3–16

    Article  CAS  PubMed  Google Scholar 

  4. Decadt B, Siriwardena AK (2004) Radiofrequency ablation of liver tumours: systematic review. Lancet Oncol 5:550–560

    Article  PubMed  Google Scholar 

  5. 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

    Article  Google Scholar 

  6. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  Google Scholar 

  9. International Agency for Research on Cancer 2012 GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012 https://gco.iarc.fr/

  10. 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

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wells SA, Hinshaw JL, Lubner MG, Ziemlewicz TJ, Brace CL, Lee FT (2015) Liver ablation: best practice. Radiol Clin North Am 53:933–971

    Article  PubMed  PubMed Central  Google Scholar 

  12. 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

    Article  PubMed  PubMed Central  Google Scholar 

  13. 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

    Chapter  Google Scholar 

  14. 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

    Article  PubMed  PubMed Central  Google Scholar 

  15. 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

    Article  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  PubMed Central  Google Scholar 

  18. 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

    Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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

    Article  PubMed  PubMed Central  Google Scholar 

  23. 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

    Article  PubMed  Google Scholar 

  24. 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

    Article  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. 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

    PubMed  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. 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

    PubMed  Google Scholar 

  30. 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

    Article  PubMed  PubMed Central  Google Scholar 

  31. 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

    Article  PubMed  PubMed Central  Google Scholar 

  32. 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

    Article  PubMed  Google Scholar 

  33. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. 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

    Article  CAS  PubMed  Google Scholar 

  35. 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

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA

    Moustafa Abdalla

  2. Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA

    Amelia T. Collings, Rebecca Dirks, Jake Whiteside & Eugene Ceppa

  3. Department of Surgery, Texas Tech University Health Sciences, Lubbock, TX, USA

    Edwin Onkendi

  4. Department of Surgery, William Beaumont Army Medical Center, Fort Bliss, TX, USA

    Daniel Nelson

  5. Department of Surgery, University of California, San Francisco - East Bay, CA, USA

    Emily Miraflor

  6. Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India

    Faique Rahman

  7. King George’s Medical University, Chowk, Lucknow, India

    Ahmad Ozair

  8. Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA

    Mihir M. Shah

  9. Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA

    Subhashini Ayloo

  10. Knowledge Synthesis, University of Manitoba, Winnipeg, MB, Canada

    Ahmed Abou-Setta

  11. Department of Surgery, University of Central Florida, Tampa, FL, USA

    Iswanto Sucandy

  12. Department of Surgery, University of Sfax, Sfax, Tunisia

    Ali Kchaou

  13. Sentara Medical Group, Norfolk, VA, USA

    Samuel Douglas

  14. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Patricio Polanco

  15. Department of Surgery, Brooke Army Medical Center, Houston, TX, USA

    Timothy Vreeland

  16. Department of Surgery and Pediatrics, Tulane University, New Orleans, LA, USA

    Joseph Buell

  17. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Mohammed T. Ansari

  18. Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA

    Aurora D. Pryor

  19. Department of Surgery, University of Chicago, Chicago, IL, USA

    Bethany J. Slater

  20. Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA

    Ziad Awad

  21. Department of Surgery, Ochsner Clinic, New Orleans, LA, USA

    William Richardson

  22. Department of Surgery, University of California San Francisco, San Francisco, CA, USA

    Adnan Alseidi

  23. Department of Surgery, TCU and UNTHSC School of Medicine, Fort Worth, TX, USA

    D. Rohan Jeyarajah

Authors
  1. Moustafa Abdalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amelia T. Collings
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rebecca Dirks
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edwin Onkendi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ahmad Ozair
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emily Miraflor
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Faique Rahman
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jake Whiteside
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mihir M. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Subhashini Ayloo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ahmed Abou-Setta
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Iswanto Sucandy
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Ali Kchaou
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Samuel Douglas
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Patricio Polanco
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Timothy Vreeland
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Joseph Buell
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Mohammed T. Ansari
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Aurora D. Pryor
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Bethany J. Slater
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Ziad Awad
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. William Richardson
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Adnan Alseidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. D. Rohan Jeyarajah
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Eugene Ceppa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eugene Ceppa.

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.

Supplementary file1 (DOCX 40 kb)

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.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09815-5

Keywords

Search

Navigation