Background

Gold standard for colorectal liver metastases (CRLM) remains hepatic resection (HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. The aim of the study was to compare recurrence rate and survival benefit of the microwave ablation (MWA), radiofrequency ablation (RFA) and HR by conducting the first network meta-analysis.

Data sources

Systematic search of the literature was conducted in the electronic databases. Both updated traditional and network meta-analyses were conducted and the results were compared between them.

Results

HR cohort demonstrated significantly less local recurrence rate and better 3- and 5-year disease-free (DFS) and overall survival (OS) compared to MWA and RFA cohorts. HR cohort included significantly younger patients and with significantly lower preoperative carcinoembryonic antigen (CEA) by 10.28 ng/mL compared to RFA cohort. Subgroup analysis of local recurrence and OS of solitary and ≤ 3 cm CRLMs did not demonstrate any discrepancies when compared with the whole sample.

Conclusions

For resectable CRLM the treatment of choice still remains HR. MWA and RFA can be used as a single or adjunct treatment in patients with unresectable CRLM and/or prohibitive comorbidities.

中文翻译：

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微波、射频消融和结直肠肝转移灶肝切除术后的复发和生存：系统评价和网络荟萃分析

背景

结直肠肝转移（CRLM）的金标准仍然是肝切除术（HR）。然而，患有严重合并症、不可切除或深部可切除 CRLM 的患者是消融的候选者。该研究的目的是通过进行第一次网络荟萃分析来比较微波消融 (MWA)、射频消融 (RFA) 和 HR 的复发率和生存获益。

数据源

在电子数据库中进行了系统的文献检索。进行了更新的传统和网络荟萃分析，并对结果进行了比较。

结果

与 MWA 和 RFA 队列相比，HR 队列的局部复发率显着降低，3 年和 5 年无病生存期 (DFS) 和总生存期 (OS) 更好。HR 队列包括显着年轻的患者，与 RFA 队列相比，术前癌胚抗原 (CEA) 显着降低 10.28 ng/mL。与整个样本相比，孤立性和≤3 cm CRLM 的局部复发和 OS 的亚组分析没有显示任何差异。

结论

对于可切除的 CRLM，选择的治疗方法仍然是 HR。MWA 和 RFA 可用作不可切除的 CRLM 和/或合并症患者的单一或辅助治疗。