Dataset Information

Efficacy and Safety of Microwave Ablation for Malignant Renal Tumors: An Updated Systematic Review and Meta-Analysis of the Literature Since 2012.

ABSTRACT:

Objective

To systematically determine the treatment outcomes of percutaneous microwave ablation (MWA) in patients with malignant renal tumor.

Materials and methods

Original studies that reported the clinical outcomes of MWA in patients with malignant renal tumors were identified in MEDLINE and EMBASE from 2012 to June 30, 2017. Inverse variance and random-effects models were used to evaluate and acquire meta-analytic summary estimates of various clinical outcomes, including technical outcomes (technical success rate [TSR] and technical efficacy rate [TER]), oncologic outcomes (local tumor recurrence rate [LRR], cancer-specific survival rate [CSSR], and overall survival rate [OSR]), and complications.

Results

Among the 145 articles screened, 13 articles including 567 patients carrying 616 malignant renal tumors were included in the meta-analysis. The meta-analytic pooled TSR and TER were 97.3% (95% confidence interval, 94.3-99.4%; I² = 0.0%) and 97.6% (95.0-99.4%, I² = 48.5%), respectively. The meta-analytic pooled LRR was 2.1% (0.3-4.7%, I² = 54.1%). At 1-, 2-, 3-, and 5-year follow-up time points, the meta-analytic pooled CSSRs were 99.1% (97.2-100.0%; I² = 0.0%), 98.4% (95.1-100.0%; I² = 31.2%), 97.6% (93.4-99.9%; I² = 52.3%), and 96.9% (93.3-99.2%; I² = 0.0%) respectively, while the OSRs were 98.3% (96.1-99.8%; I² = 0.0%), 94.9% (91.7-97.5%; I² = 0.0%), 86.8% (81.9-91.1%; I² = 22.1%), and 81.9% (75.4-87.6%; I² = 0.0%). In terms of major complications, a 1.8% (0.6-3.3%; I² = 0.0%) rate of meta-analytic pooled incidence was found.

Conclusion

Microwave ablation showed favorable technical and oncologic outcomes with a low incidence of major complications. Hence, image-guided percutaneous MWA can be considered as a safe and effective treatment for malignant renal tumors.

SUBMITTER: Choi SH

PROVIDER: S-EPMC6082757 | biostudies-literature | 2018 Sep-Oct

REPOSITORIES: biostudies-literature

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Publications

Efficacy and Safety of Microwave Ablation for Malignant Renal Tumors: An Updated Systematic Review and Meta-Analysis of the Literature Since 2012.

Choi Sang Hyun SH Kim Jong Woo JW Kim Jin Hyoung JH Kim Kyung Won KW

Korean journal of radiology 20180806 5

<h4>Objective</h4>To systematically determine the treatment outcomes of percutaneous microwave ablation (MWA) in patients with malignant renal tumor.<h4>Materials and methods</h4>Original studies that reported the clinical outcomes of MWA in patients with malignant renal tumors were identified in MEDLINE and EMBASE from 2012 to June 30, 2017. Inverse variance and random-effects models were used to evaluate and acquire meta-analytic summary estimates of various clinical outcomes, including techni ...[more]

PMID: 30174484

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Project description:IntroductionNovel oral anticoagulants (NOACs) have been approved for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). A large number of patients are on NOACs when they present for AF ablation. We intended to evaluate the safety and efficacy of NOACs for AF ablation during the periprocedural period by performing a meta-analysis of trials comparing NOACs with warfarin.MethodsStudies comparing NOACs (dabigatran and rivaroxaban) with warfarin as periprocedural anticoagulants for AF ablation were identified using an electronic search. Primary outcomes were: (1) a composite endpoint of stroke, transient ischemic attack (TIA), peripheral arterial embolism, or silent cerebral lesions on magnetic resonance imaging (MRI) and (2) major bleeding complications. A random effects model was used to pool the safety and efficacy data across all included trials.ResultsWhen compared to warfarin, there was an increased risk of the composite endpoint of stroke, TIA, peripheral arterial embolism, or silent cerebral lesions on MRI with NOACs as periprocedural anticoagulants for AF ablation [odds ratio (OR): 1.69, 95% confidence interval (CI): 1.06-2.68]. Sub-group analysis revealed a higher risk of composite endpoint with dabigatran as a periprocedural anticoagulant for AF ablation (OR: 2.01, 95% CI: 1.19-3.39) whereas the risk was similar with rivaroxaban (OR: 0.90, 95% CI: 0.34-2.41). Sensitivity analysis after excluding silent cerebral lesions on MRI showed there was no increased risk of thromboembolic events with either dabigatran (OR: 1.69, 95% CI: 0.81-3.51) or rivaroxaban (OR: 0.70, 95% CI: 0.12-4.04). Risk of bleeding with NOACs was similar to warfarin (OR: 0.91, 95% CI: 0.62-1.34).ConclusionNOACs are comparable to warfarin in terms of bleeding complications. However, dabigatran therapy is potentially associated with a higher risk of silent cerebral lesions on MRI. The results of this study should be considered as hypothesis-generating and assessed further in prospective randomized clinical studies.

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Dataset Information

Efficacy and Safety of Microwave Ablation for Malignant Renal Tumors: An Updated Systematic Review and Meta-Analysis of the Literature Since 2012.

Objective

Materials and methods

Results

Conclusion

Publications

Efficacy and Safety of Microwave Ablation for Malignant Renal Tumors: An Updated Systematic Review and Meta-Analysis of the Literature Since 2012.

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