Comparative efficacy of different thermal ablation and conventional surgery for the treatment of Papillary Thyroid Microcarcinoma: Systematic review including traditional pooling and Bayesian network meta-analysis

Abstract

Purpose

To compare the efficacy of different thermal ablation and conventional surgery for the treatment of Papillary Thyroid Microcarcinoma, using a systematic review including traditional pooling and Bayesian network meta-analysis.

Materials and methods

A comprehensive literature search in PubMed, EMBASE, and the Cochrane Library databases identified retrospective studies evaluating the tumor volume change after different thermal ablation or conventional surgery. Studies from the date of their inception to January 6, 2024, were included. A review of 4463 potential papers, including a full-text review of 23, identified 10 eligible papers covering a total of 2658 patients for meta-analysis. The tumor volume change over a 12-month follow-up was compared between different thermal ablations. Tumor diameter change, complications, recurrence, operation and hospitalization time were evaluated by network meta-analysis.

Results

Based on the traditional frequentist approach, the overall pooled estimates for the standardized mean difference (SMD) in tumor volume change of radiofrequency ablation (RFA), laser ablation (LA), and microwave ablation (MWA) were 1.38 (95 % credibility interval (CI), 0.62–2.13), 1.94 (95%CI, 0.78–3.10) and 1.38 (95%CI, 1.01–1.75), respectively. Based on the Bayesian network meta-analysis, in examining the surface under the cumulative ranking area (SUCRA) ranking, RFA (SUCRA, 76.6), MWA (SUCRA, 66.6), and LA (SUCRA, 39.8) were identified as the three interventions that were associated with the greatest reduction in risk for complications compared with conventional surgery (CS), with RFA (SUCRA, 76.6) being ranked as the highest in safety. MWA, SMD 4.43 [95%CI, 2.68–6.17], RFA SMD 4.24 [95 % CI, 1.66–6.82], and LA SMD 4.24 [95 % CI, 1.48–7.00] were associated with the shorter operation time compared with CS. LA SMD 4.61 [95 % CI, 1.79–7.44] and MWA SMD 3.07 [95 % CI, 1.32–4.83] were associated with the shorter hospitalization time compared with CS, with LA (SUCRA, 86.5) yielding the highest ranking. MWA was associated with a reduced risk for tumor recurrence RR 0.02 [95 % CI, −0.44-0.49], compared with CS.

Conclusion

We conducted a comprehensive review of the published literature on the effectiveness and safety of different thermal ablation techniques and conventional surgery for papillary thyroid microcarcinoma. Important research gaps persist due to a lack of long-term data and high-quality randomized controlled trials (RCTs).