Comparison of microwave ablation and hepatic resection for hepatocellular carcinoma: a meta-analysis

Abstract

Background and aims: Hepatic resection (HRN) and microwave ablation (MWA) have significant advantages in treating hepatocellular carcinoma; however, it remains unclear which way produces better outcomes. This meta-analysis of cohort studies compared the treatments in terms of effectiveness and safety.

Methods: Six electronic databases (PubMed, Medline, EMBASE, Web of Science, EBSCO, and The Cochrane Library) were retrieved for studies comparing MWA and HRN. The meta-analysis was conducted based on statement of preferred reporting items for systematic reviews and meta-analyses.

Results: Nine studies met the inclusion criteria, with a total of 1,480 patients. The overall meta-analysis demonstrated no significant difference in overall survival between the MWA group and the HRN group (HR =0.98, 95% CI =0.76-1.26, P=0.878). There was no difference in disease-free survival between the MWA group and the HRN group (HR =1.16, 95% CI =0.79-1.71, P=0.442). Meanwhile, the meta-analysis demonstrated that MWA was associated with shorter operation time (standardized mean difference [SMD] =-1.37, 95% CI =-1.92 to -0.81, P=0.000), less amount of blood loss in operation (SWD =-1.19, 95% CI =-1.76 to -0.61, P=0.000), and less complications (OR =0.22, 95% CI =0.12-0.40, P=0.000) than HRN.

Conclusion: In conclusion, our meta-analysis suggests that MWA may be superior to HRN as it is as effective as HRN in terms of overall survival, disease-free survival, tumor recurrence, and is associated with shorter operation time, less amount of blood loss, and fewer complications.

Keywords: hepatic resection; microwave ablation; primary hepatic carcinoma; survival analysis.

Figure 1

Flow chart showing selection of studies for meta-analysis. Abbreviations: MWA, microwave ablation; HRN, hepatic resection; HCC, hepatocellular carcinoma.

Figure 2

Forest plot of meta-analysis comparing the OS between MWA and HRN (pooled with HR). Abbreviations: MWA, microwave ablation; OS, overall survival; HRN, hepatic resection.

Figure 3

Funnel plot for assessing publication bias in OS. Abbreviations: HR, hazard ratio; OS, overall survival; SE, standard error.

Figure 4

(A) Forest plot of meta-analysis comparing the OS between MWA and HRN (pooled with HR). Comparison of patients with HCC <3 cm. (B) Forest plot of meta-analysis comparing the OS between MWA and HRN (pooled with HR). Comparison of PMCT with HRN. Abbreviations: HCC, hepatocellular carcinoma; MWA, microwave ablation; OS, overall survival; PMCT, percutaneous microwave coagulation therapy; HRN, hepatic resection.

Figure 5

Forest plot of meta-analysis comparing the OS between MWA and HRN (pooled with OR). Abbreviations: MWA, microwave ablation; OS, overall survival; HRN, hepatic resection.

Figure 6

Forest plot of meta-analysis comparing the DFS between MWA and HRN (pooled with HR). Note: Weights are from random effects analysis. Abbreviations: DFS, disease-free survival; MWA, microwave ablation; HRN, hepatic resection.

Figure 7

Funnel plot for assessing publication bias in DFS. Abbreviation: DFS, disease-free survival.

Figure 8

(A) Forest plot of meta-analysis comparing the DFS between MWA and HRN (pooled with HR). Comparing the patients with HCC smaller than 3 cm. Weights are from random effects analysis. (B) Forest plot of meta-analysis comparing the DFS between MWA and HRN (pooled with HR). Comparing PMCT with HRN. Abbreviations: DFS, disease-free survival; HCC, hepatocellular carcinoma; MWA, microwave ablation; PMCT, percutaneous microwave coagulation therapy; HRN, hepatic resection.

Figure 9

Forest plot of meta-analysis comparing the tumor recurrence between MWA and HRN (pooled with OR). Abbreviations: MWA, microwave ablation; HRN, hepatic resection.

Figure 10

(A) Forest plot of meta-analysis comparing operation time between MWA and HRN. (B) Forest plot of meta-analysis comparing blood loss between MWA and HRN. (C) Forest plot of meta-analysis comparing complication between MWA and HRN. Weights are from random effects analyses. Abbreviations: MWA, microwave ablation; SMD, standardized mean difference; HRN, hepatic resection.