Radiofrequency Thermal Ablation vs. Percutaneous Ethanol Injection for Small Hepatocellular Carcinoma in Cirrhosis: Meta-Analysis of Randomized Controlled Trials

The role of adjuvant transarterial chemoembolization (TACE) for patients with resectable hepatocellular carcinoma (HCC) undergoing hepatectomy is currently unclear. We performed a systematic review of the literature using the MEDLINE, Embase, and Cochrane Library databases. Random-effects meta-analysis was carried out to compare the overall survival (OS) and recurrence-free survival (RFS) of patients with resectable HCC undergoing hepatectomy followed by adjuvant TACE vs. hepatectomy alone in randomized controlled trials (RCTs). The risk of bias was assessed using the Risk of Bias 2.0 tool. Meta-regression analyses were performed to explore the effect of hepatitis B viral status, microvascular invasion, type of resection (anatomic vs. parenchymal-sparing), and tumor size on the outcomes. Ten eligible RCTs, reporting on 1216 patients in total, were identified. The combination of hepatectomy and adjuvant TACE was associated with superior OS (hazard ratio (HR): 0.66, 95% confidence interval (CI): 0.52 to 0.85; p < 0.001) and RFS (HR: 0.70, 95% CI: 0.56 to 0.88; p < 0.001) compared to hepatectomy alone. There were significant concerns regarding the risk of bias in most of the included studies. Overall, adjuvant TACE may be associated with an oncologic benefit in select HCC patients. However, the applicability of these findings may be limited to Eastern Asian populations, due to the geographically restricted sample. High-quality multinational RCTs, as well as predictive tools to optimize patient selection, are necessary before adjuvant TACE can be routinely implemented into standard practice. PROSPERO Registration ID: CRD42021245758.

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Percutaneous microwave ablation versus radiofrequency ablation of hepatocellular carcinoma: a meta-analysis of randomized controlled trials

Abdominal Radiology ◽

10.1007/s00261-021-03080-1 ◽

2021 ◽

Author(s):

Qian Yu ◽

Chenyu Liu ◽

Rakesh Navuluri ◽

Osman Ahmed

Keyword(s):

Hepatocellular Carcinoma ◽

Radiofrequency Ablation ◽

Randomized Controlled Trials ◽

Microwave Ablation ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Percutaneous Microwave Ablation

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Thromboembolic complications of endovenous thermal ablation and foam sclerotherapy in the treatment of great saphenous vein insufficiency

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514529948 ◽

2014 ◽

Vol 30 (5) ◽

pp. 357-364 ◽

Cited By ~ 17

Author(s):

Meghan Dermody ◽

Marlin W Schul ◽

Thomas F O’Donnell

Keyword(s):

Venous Thromboembolism ◽

Randomized Controlled Trials ◽

Thermal Ablation ◽

Meta Analysis ◽

Case Series ◽

Controlled Trials ◽

Foam Sclerotherapy ◽

Bootstrap Analysis ◽

Randomized Controlled ◽

Endovenous Thermal Ablation

Objective Portions of these data were presented in a poster at the XVII World Meeting of the International Union of Phlebology, 8–13 September 2013, Boston, MA, USA. We assessed the incidence of venous thromboembolism following treatment of great saphenous insufficiency by endovenous thermal ablation or foam sclerotherapy using meta-analysis of published randomized controlled trials and case series. Methods Medline, Embase, Cochrane, and Clinical Trials Registry databases were searched from January 2000 through January 2013 for randomized controlled trials and large case series employing endovenous thermal ablation or foam sclerotherapy as a single modality for the treatment of great saphenous insufficiency, with concomitant postoperative duplex scanning. Pooled (stratified) incidence of venous thromboembolism with 95% confidence intervals was estimated using the DerSimonian–Laird procedure for random effects meta-analysis. A bootstrap analysis was performed to examine between-modality differences. Results Twelve randomized controlled trials and 19 case series investigating endovenous thermal ablation (radiofrequency ablation with VNUS/Covidien ClosureFAST™ catheter only, endovenous laser ablation, or both) were included. Data from 12 randomized controlled trials and 6 case series investigating nonproprietary foam preparations were analyzed. Estimated incidence of venous thromboembolism was low (mostly <1%) and similar across treatment modalities and study types. Conclusions Treatment of great saphenous insufficiency by endovenous thermal ablation or foam sclerotherapy is a common vascular intervention. The stratified incidence of venous thromboembolism appears to be low as reported in both randomized controlled trials and case series investigating these modalities. Although duplex scans were obtained postoperatively, a minority of studies specified protocols for venous thromboembolism detection.

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