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Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: a systematic review

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Abstract

Objectives

Reported rates of major complications and mortality of radiofrequency ablation (RFA), microwave ablation (MWA) and percutaneous ethanol injection (PEI) for the treatment of liver tumours were substantially heterogeneous among studies. The aim was to analyse the mortality and major complication rates of percutaneous RFA, PEI and MWA.

Methods

MEDLINE and EMBASE search from January 1982 to August 2010. Randomised clinical trials and observational studies, age >18, more than 50 patients for each technique analysed, studies reporting mortality and major complications were included. Random effects model was performed, with assessment for heterogeneity and publication bias.

Results

Thirty-four studies including 9531, 1185, and 1442 patients for RFA, MWA, and PEI, respectively were included. For all ablative techniques pooled proportion mortality rate was 0.16% (95% confidence interval [CI], 0.10–0.24). Pooled mortality rate associated with RFA, PEI and MWA was 0.15% (0.08–0.23), 0.59% (0.14–1.3) and 0.23% (0.0–0.58) respectively. Pooled proportion of major complications was 3.29% (2.43–4.28). Major complication rates associated with RFA, MWA, and PEI was 4.1% (3.3–5.1), 4.6% (0.7–11.8) and 2.7% (0.28–7.4) respectively.

Conclusions

Percutaneous RFA, PEI and MWA can be considered safe techniques for the treatment of liver tumours.

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Abbreviations

HCC:

Hepatocellular carcinoma

RFA:

Radiofrequency ablation

PEI:

Percutaneous ethanol injection

MWA:

Microwave ablation

CI:

Confidence interval

CRC:

Colorectal cancer

CT:

Computed tomography

MRI:

Magnetic resonance imaging

SIR:

Society of interventional radiology

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Acknowledgement

This work was supported in part by Health Sciences Research Grants of The Ministry of Health, Labour and Welfare of Japan (Research on Hepatitis).The supporters had no role in study design; collection, analysis, interpretation of data; writing of the report or decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Luis Calzadilla Bertot, Masaya Sato, Ryosuke Tateishi, Haruhiko Yoshida & Kazuhiko Koike

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  1. Luis Calzadilla Bertot
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  2. Masaya Sato
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  3. Ryosuke Tateishi
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  4. Haruhiko Yoshida
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Correspondence to Ryosuke Tateishi.

Additional information

Search terms for databases.

For PubMed,

“Liver Neoplasms”[majr] AND (“Ethanol Injection”[TIAB] OR “Ablation”[TIAB] OR “Ablative therapy”[TIAB] OR “Thermal Ablation”[TIAB] OR “radiofrequency”[TIAB] OR “RFA”[TIAB] OR “PEI”[TIAB] OR “PEIT”[TIAB] OR “Ethanol/administration and dosage”[MH] OR “Injections, Intralesional”[MH] OR “microwave”[TIAB]) AND 1982/1: 2010/8[dp]) NOT Review[pt] NOT Case reports[pt]

For EMBASE

(ethanol:ab AND injection:ab) OR ablation:ab OR (ablative:ab AND therapy:ab) OR (thermal:ab AND ablation:ab) OR radiofrequency:ab OR rfa:ab OR pei:ab OR peit:ab OR microwave:ab OR (ethanol:ti AND injection:ti) OR ablation:ti OR (ablative:ti AND therapy:ti) OR (thermal:ti AND ablation:ti) OR radiofrequency:ti OR rfa:ti OR pei:ti OR peit:ti AND ‘liver tumor’/exp/mj AND [english]/lim AND [1-1-1982]/sd NOT [1-8-2010]/sd NOT [review]/lim NOT [medline]/lim

Appendix

Appendix

Table 6 Quality assessment tool for studies reporting complications of ablative techniques for the treatment of liver tumors
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Fig. 4
figure 4

Metaregression models with covariates restricted to major complications of radiofrequency ablation

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Bertot, L.C., Sato, M., Tateishi, R. et al. Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: a systematic review. Eur Radiol 21, 2584–2596 (2011). https://doi.org/10.1007/s00330-011-2222-3

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  • DOI: https://doi.org/10.1007/s00330-011-2222-3

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