Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: a systematic review

Objectives Reported rates of major complications and mortality of radiofrequency ablation (RFA), microwave ablation (MWA) and percutaneous ethanol injection (PEI) for the treatment of liver tumours were substantially heterogeneous among studies. The aim was to analyse the mortality and major complication rates of percutaneous RFA, PEI and MWA. Methods MEDLINE and EMBASE search from January 1982 to August 2010. Randomised clinical trials and observational studies, age >18, more than 50 patients for each technique analysed, studies reporting mortality and major complications were included. Random effects model was performed, with assessment for heterogeneity and publication bias. Results Thirty-four studies including 9531, 1185, and 1442 patients for RFA, MWA, and PEI, respectively were included. For all ablative techniques pooled proportion mortality rate was 0.16% (95% confidence interval [CI], 0.10–0.24). Pooled mortality rate associated with RFA, PEI and MWA was 0.15% (0.08–0.23), 0.59% (0.14–1.3) and 0.23% (0.0–0.58) respectively. Pooled proportion of major complications was 3.29% (2.43–4.28). Major complication rates associated with RFA, MWA, and PEI was 4.1% (3.3–5.1), 4.6% (0.7–11.8) and 2.7% (0.28–7.4) respectively. Conclusions Percutaneous RFA, PEI and MWA can be considered safe techniques for the treatment of liver tumours.