Related Experiment Video
Updated: Aug 6, 2026
Application of Laparoscopic Hepatectomy Combined with Intraoperative Microwave Ablation in Colorectal Cancer Liver Metastasis
Published on: March 3, 2023
Image-guided radiofrequency versus microwave ablation for small to medium hepatocellular carcinoma: a meta-analysis
1Department Of Radiology, The Second Xiang Ya Hospital Of Central South University, Changsha, China.
Objective:
This meta-analysis was conducted to compare the clinical efficacy and safety of image-guided radiofrequency ablation (RFA) versus microwave ablation (MWA) for the treatment of small to medium-sized hepatocellular carcinoma (HCC).
Methods:
A systematic search of four English databases (PubMed, Web of Science, Cochrane Library, EMBASE) was performed up to January 8, 2026. Randomized controlled trials (RCTs) and cohort studies comparing RFA and MWA for HCC were included. The Cochrane Risk of Bias tool (RoB 2.0) and the Newcastle-Ottawa Scale (NOS) were used for quality assessment of RCTs and cohort studies, respectively. Evidence certainty was evaluated via the GRADE system. Statistical analyses were performed using Review Manager 5.4 and Stata 18, with results expressed as relative risk (RR) and 95% confidence interval (CI). The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD420261297809).
Results:
Nineteen studies (6 RCTs, 13 cohort studies) were included. No statistically significant differences were observed between RFA and MWA in the complete ablation rate (RR = 1.00, 95% CI 0.98-1.01, P = 0.84), 5-year overall survival (RR = 0.99, 95% CI 0.93-1.05, P = 0.67), 1-year disease-free survival (RR = 0.97, 95% CI 0.90-1.04, P = 0.45), or incidence of major adverse events (RR = 0.93, 95% CI 0.69-1.27, P = 0.66). An initial analysis suggested a superior 1-year overall survival for MWA (RR = 0.97, 95% CI 0.95-0.99, P = 0.008), but this difference was not sustained after excluding studies with a high risk of bias (P = 0.05). Substantial heterogeneity was present for 5-year disease-free survival (I²=81%). The overall certainty of evidence was rated low per GRADE.
Conclusion:
For small to medium-sized HCC, image-guided RFA and MWA exhibit comparable core efficacy and safety. Treatment selection should be individualized based on tumor characteristics, institutional resources, and operator expertise. The findings concerning 5-year disease-free survival require cautious interpretation. Future large-scale, multicenter RCTs with standardized protocols are needed for definitive validation.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD420261297809, identifier CRD420261297809.
