背景:根据肿瘤的生物学特性,微波消融(MWA)已成为肝恶性肿瘤患者的标准热基治疗方法,病人的合并症,某些疾病部位。技术有效性,消融成功,使用各种商业微波消融装置治疗的肝脏恶性肿瘤的局部复发率以前尚未在同行评审的文献中发表.本系统综述的目的是总结各种MWA设备在使用肝脏恶性肿瘤时的临床结果,以最好地教育肝脏外科医生和介入放射科医生。
方法:对2013年1月至2020年12月发布的每种设备的使用文献和说明进行了全面回顾。提取的主要结果是技术成功,消融成功,主要并发症,局部和新的复发率,无复发生存率,消融体积,时间,以及所需的天线数量。对文献进行了定性综述。
结果:总计,该综述包括29项报告3250例患者和4500例肿瘤数据的研究。中位患者年龄为60.5岁(范围3-91岁)。76.3%(2420M/753F)的患者为男性。肝细胞癌(55%)是最常见的肿瘤病理,其次是结直肠癌肝转移(10%)和胆管癌(4%)。大多数研究报告了技术上的成功(范围,91.6-100%)和消融成功率(范围,73.1-100%),以及主要并发症(范围,0-9.1%)。局部复发(范围,0-50%)是由21项研究报告的;然而,新复发(范围,12.2-64%)报道频率较低(6项研究),并在12项、6项、和四个研究肝内远处复发(11.3-54.2%),肝外远处复发(3.6-20%),和转移(1.1-36%)。一共三个,六,五项研究报告了疾病,programming,和无复发生存率,分别。
结论:微波消融常用于肝脏恶性肿瘤的治疗。全面了解与不同病理和MWA设备相关的临床结果可以提高外科医生的意识,并帮助为手术计划和患者管理做好准备。为了实现这种理解,需要在文献中对关键结果进行更一致的报告。
Microwave ablation (MWA) has become the standard thermal-based treatment for hepatic malignancies in patients who have unresectable disease based on the biology of the tumor, the patients\' comorbidities, and certain disease sites. The technical effectiveness, ablation success, local recurrence rates of hepatic malignancies treated with the various commercial microwave ablation devices has not been previously published in the peer reviewed literature. The aim of this systematic
review is to summarize the clinical outcomes for the various MWA devices in the use of a hepatic malignancies to best educate hepatic surgeons as well as interventional radiologists.
A comprehensive
review of the literature and instructions for use of each device that was published from 1/2013 to 12/2020 was performed. The main outcomes extracted were technical success, ablation success, major complications, local and new recurrence rates, recurrence-free survival, ablation volumes, time, and the number of antennas required. A qualitative
review of the literature was performed.
In total, 29 studies reporting data on 3250 patients and 4500 tumors were included in this
review. Median patient age was 60.5 years (range 3-91). 76.3% (2420 M/753 F) of patients were male. Hepatocellular carcinoma (55%) was the most common tumor pathology followed by colorectal liver metastasis (10%) and cholangiocarcinoma (4%). A majority of studies reported technical success (range, 91.6-100%) and ablation success (range, 73.1-100%), as well as major complications (range, 0-9.1%). Local recurrence (range, 0-50%) was reported by 21 of the studies; however, new recurrence (range, 12.2-64%) was reported less frequently (6 studies) and were further specified in 12, six, and four studies as intrahepatic distant recurrence (11.3-54.2%), extrahepatic distant recurrence (3.6-20%), and metastasis (1.1-36%). A total of three, six, and five studies report disease, progression, and recurrence-free survival rates, respectively.
Microwave ablation is frequently used for the treatment of hepatic malignancies. A thorough understanding of the clinical outcomes associated with different pathologies and MWA devices can improve surgeon awareness and help prepare for operative planning and patient management. More consistent reporting of key outcomes in the literature is needed to achieve such an understanding.