Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumors: A Systematic Review and Meta-Analysis

Abstract

BackgroundStereotactic navigation techniques aim to enhance treatment precision and safety in minimally invasive thermal ablation of liver tumors. We qualitatively reviewed and quantitatively summarized the available literature on procedural and clinical outcomes after stereotactic navigated ablation of malignant liver tumors.MethodsA systematic literature search was performed on procedural and clinical outcomes when using stereotactic or robotic navigation for laparoscopic or percutaneous thermal ablation. The online databases Medline, Embase, and Cochrane Library were searched. Endpoints included targeting accuracy, procedural efficiency, and treatment efficacy outcomes. Meta-analysis including subgroup analyses was performed.ResultsThirty-four studies (two randomized controlled trials, three prospective cohort studies, 29 case series) were qualitatively analyzed, and 22 studies were included for meta-analysis. Weighted average lateral targeting error was 3.7 mm (CI 3.2, 4.2), with all four comparative studies showing enhanced targeting accuracy compared to free-hand targeting. Weighted average overall complications, major complications, and mortality were 11.4% (6.7, 16.1), 3.4% (2.1, 5.1), and 0.8% (0.5, 1.3). Pooled estimates of primary technique efficacy were 94% (89, 97) if assessed at 1–6 weeks and 90% (87, 93) if assessed at 6–12 weeks post ablation, with remaining between-study heterogeneity. Primary technique efficacy was significantly enhanced in stereotactic vs. free-hand targeting, with odds ratio (OR) of 1.9 (1.2, 3.2) (n = 6 studies).ConclusionsAdvances in stereotactic navigation technologies allow highly precise and safe tumor targeting, leading to enhanced primary treatment efficacy. The use of varying definitions and terminology of safety and efficacy limits comparability among studies, highlighting the crucial need for further standardization of follow-up definitions.

Robotic versus freehand CT-guided radiofrequency ablation of pulmonary metastases: a comparative cohort study

“…A handful of studies have shown that traversal of a greater length of lung parenchyma is associated with higher rates of pneumothorax [23][24][25][26], likewise fissure traversal, and ablation zones which encompass pleura [27]. Since all these factors can be influenced by careful multiplanar planning, including Although robotic lung tumor ablation is poorly established in the literature, our results are similar to stereotactic liver ablation, were our Euclidian error of 5.1 mm is very similar to the pooled error of 5.3 mm in a recent meta-analysis [12]. The high level of trust we developed in our technique meant we used smaller array diameter electrodes than in freehand procedures (3.0 vs. 3.5 mm, P = 0.001), without a need for more overlapping ablation zones (P > 0.99), although broad umbrella electrode configuration means a few millimeters of imprecision can usually be tolerated.…”

3D Quantitative Ablation Margins for Prediction of Ablation Site Recurrence After Stereotactic Image-Guided Microwave Ablation of Colorectal Liver Metastases: A Multicenter Study

“…Thermal ablation such as microwave ablation (MWA) is a tissuesparing treatment alternative to hepatic resection in selected patients, yielding similar treatment efficacy, recurrence-free survival, and overall survival as described in non-randomized studies (1)(2)(3)(4)(5). Treatment efficacy can be significantly enhanced by using stereotactic navigation technology for precise targeting of liver tumors as opposed to conventional targeting techniques (6,7).…”

Stereotactic Microwave Ablation of Hepatocellular Carcinoma: The Impact of Tumor Size and Minimal Ablative Margin on Therapeutic Success

“…Possible explanations for the different results of the studies could be the different characteristics of heat generation and distribution in MWA and RFA and, at least in comparison to Wang, the different tumor characteristics of HCC and colorectal liver metastases. Another possible explanation for the differing results could be the use of a stereotactic navigation system in combination with MWA because those methods seem to achieve better results regarding PTE and, respectively, OS in larger HCC lesions [ 32 , 36 , 37 ] settings, where conventional percutaneous ablation techniques show an incline in PTE and prognosis [ 3 ]. Further studies regarding these questions would be of interest.…”