Efficacy and safety of microwave ablation treatment for secondary hyperparathyroidism: systematic review and meta-analysis

Abstract

Purpose: The present systematic review and meta-analysis was designed to evaluate the efficacy and safety of microwave ablation (MWA) treatment for secondary hyperparathyroidism (SHPT). Materials and methods: The study authors systematically searched the Web of Science, Cochrane Library, PubMed, Embase and Ovid databases for studies published in English prior to 7October 2019. All studies included in the meta-analysis measured levels of parathyroid hormone (PTH), calcium and phosphorus, and included data related to complications following MWA treatment for SHPT. Results: The meta-analysis ultimately included 233 patients from two retrospective cohort studies and six retrospective self-control studies. Compared to PTH level measurements obtained after MWA, measurements obtained at one day (weighted mean differences (WMD): 890.314, 95% confidence interval (CI): 767.121-1013.506, p < 0.01) , one week (WMD: 860.298, 95% CI: 759.401-961.194, p < 0.01), one month (WMD: 800.846, 95% CI: 687.709-913.983, p < 0.01) and six months (WMD: 860.847, 95% CI: 745.214-976.480, p < 0.01) after MWA were significantly lower. Calcium and phosphorus levels at one day and one week after MWA were also significantly lower than those measured before MWA. After MWA, the incidence of nerve injury was 1.2% (3/233; effect size (ES): 0.022, 95% CI: À0.003-0.048, p < 0.01). After MWA, the incidence of hypocalcemia was 15.8% (37/233; ES: 0.449, 95% CI: 0.341-0.556, p < 0.01). Conclusion: The preliminary results of this meta-analysis indicate that MWA may be effective and safe in treating patients with SHPT, and that future prospective research and randomized controlled trials (RCT) are necessary.

Long‐term outcomes of microwave ablation for secondary hyperparathyroidism in maintenance hemodialysis patients

“…[3][4][5][6][7][8] Microwave ablation, as a minimally invasive therapeutic approach causing parathyroid cells to lose their endocrine functionality, has been increasingly used to treat SHPT. [9][10][11][12][13] Our preliminary study also shows that microwave ablation could be an alternative for secondary hyperparathyroidism in patients with maintenance hemodialysis. The long-term superiority of microwave ablation, however, should be clarified further.…”

“…Recently, a meta-analysis including 233 patients with follow-up duration up to 23 months indicated that microwave ablation may be effective and safe in treating SHPT patients. 11 Another comparative study on microwave ablation vs. parathyroidectomy suggested microwave ablation is an alternative and may be before parathyroidectomy. 14 In addition, microwave ablation may also be effective and safe to manage recurrent and persistent SHPT after parathyroidectomy.…”

Ultrasound-guided microwave ablation for secondary hyperparathyroidism: a systematic review and meta-analysis

“…Our meta-analysis results revealed that PTH, serum calcium and phosphorus levels were significantly reduced at week 1, 1 month, 6 months and end of the follow-up period after MWA of SHPT patients. Different from the results of previous meta-analysis study [51], the current meta-analysis study has fully gathered the data from a wide range of results and provided more indepth insights on important clinical results. Also, due to the inclusion of additional studies and larger amounts of pooling, the results are different from that of the previous metaanalysis.…”

“…Also, due to the inclusion of additional studies and larger amounts of pooling, the results are different from that of the previous metaanalysis. A previous meta-analysis conducted by Cao et al [51] has been limited due to inclusion of only eight studies that compared pre-ablative and post-ablative clinical results. The present study included 18 additional eligible studies.…”

Recommend-Response and Complications Comparing Radiofrequency Ablation Versus Parathyroidectomy for Secondary Hyperparathyroidism in Dialysis Patients

“…Ultrasound-guided percutaneous ablation therapy is minimally invasive and reproducible, and has been more widely used to treat hyperparathyroidism. Some previous studies showed that MWA or RFA could indeed reduce PTH levels and is effective for SHPT [10][11][12] , and are not inferior to PTX in safety and e cacy 7,12−15 , but the comparisons of PTX and RFA in hospital stay, economic costs, and especially long-term results are less.…”