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. 2021 Sep 23:11:713685.
doi: 10.3389/fonc.2021.713685. eCollection 2021.

Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumors: A Systematic Review and Meta-Analysis

Pascale Tinguely  1   2 , Iwan Paolucci  3 , Simeon J S Ruiter  4 , Stefan Weber  3 , Koert P de Jong  4 , Daniel Candinas  2 , Jacob Freedman  1 , Jennie Engstrand  1
Affiliations

Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumors: A Systematic Review and Meta-Analysis

Pascale Tinguely et al. Front Oncol. .

Abstract

Background: Stereotactic navigation techniques aim to enhance treatment precision and safety in minimally invasive thermal ablation of liver tumors. We qualitatively reviewed and quantitatively summarized the available literature on procedural and clinical outcomes after stereotactic navigated ablation of malignant liver tumors.

Methods: A systematic literature search was performed on procedural and clinical outcomes when using stereotactic or robotic navigation for laparoscopic or percutaneous thermal ablation. The online databases Medline, Embase, and Cochrane Library were searched. Endpoints included targeting accuracy, procedural efficiency, and treatment efficacy outcomes. Meta-analysis including subgroup analyses was performed.

Results: Thirty-four studies (two randomized controlled trials, three prospective cohort studies, 29 case series) were qualitatively analyzed, and 22 studies were included for meta-analysis. Weighted average lateral targeting error was 3.7 mm (CI 3.2, 4.2), with all four comparative studies showing enhanced targeting accuracy compared to free-hand targeting. Weighted average overall complications, major complications, and mortality were 11.4% (6.7, 16.1), 3.4% (2.1, 5.1), and 0.8% (0.5, 1.3). Pooled estimates of primary technique efficacy were 94% (89, 97) if assessed at 1-6 weeks and 90% (87, 93) if assessed at 6-12 weeks post ablation, with remaining between-study heterogeneity. Primary technique efficacy was significantly enhanced in stereotactic vs. free-hand targeting, with odds ratio (OR) of 1.9 (1.2, 3.2) (n = 6 studies).

Conclusions: Advances in stereotactic navigation technologies allow highly precise and safe tumor targeting, leading to enhanced primary treatment efficacy. The use of varying definitions and terminology of safety and efficacy limits comparability among studies, highlighting the crucial need for further standardization of follow-up definitions.

Keywords: ablation techniques; computer-assisted therapies; liver neoplasms; minimally invasive surgical procedures; stereotaxic techniques.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of study selection after systematic literature review.
Figure 2
Figure 2
Distribution of reported endpoints over time (n = 34 studies).
Figure 3
Figure 3
Forest plot for pooled estimate of lateral targeting error.
Figure 4
Figure 4
Forest plot for pooled estimates of major complication rates according to definitions of morbidity.
Figure 5
Figure 5
Definitions and time points of reported follow-up assessments.
Figure 6
Figure 6
Forest plot of pooled odds ratio of primary technique efficacy after stereotactic vs. free-hand targeting.
Figure 7
Figure 7
Forest plot for pooled estimates of primary technique efficacy rates according to time points of first follow-up.
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References

    1. Bruix J, Reig M, Sherman M. Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma. Gastroenterology (2016) 150(4):835–53. doi: 10.1053/j.gastro.2015.12.041 - DOI - PubMed
    1. Lencioni R, de Baere T, Martin RC, Nutting CW, Narayanan G. Image-Guided Ablation of Malignant Liver Tumors: Recommendations for Clinical Validation of Novel Thermal and Non-Thermal Technologies - A Western Perspective. Liver Cancer (2015) 4(4):208–14. doi: 10.1159/000367747 - DOI - PMC - PubMed
    1. European Association for the Study of the Liver . Electronic Address: Easloffice@Easloffice.Eu, European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of Hepatocellular Carcinoma. J Hepatol (2018) 69(1):182–236. doi: 10.1016/j.jhep.2018.03.019 - DOI - PubMed
    1. Van Cutsem E, Cervantes A, Adam R, Sobrero A, Van Krieken JH, Aderka D, et al. . ESMO Consensus Guidelines for the Management of Patients With Metastatic Colorectal Cancer. Ann Oncol Off J Eur Soc Med Oncol (2016) 27(8):1386–422. doi: 10.1093/annonc/mdw235 - DOI - PubMed
    1. Crocetti L, de Baere T, Lencioni R. Quality Improvement Guidelines for Radiofrequency Ablation of Liver Tumours. Cardiovasc Intervent Radiol (2010) 33(1):11–7. doi: 10.1007/s00270-009-9736-y - DOI - PMC - PubMed

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