Wu Xiaoyu, Jiang Zixuan, Liu Jie, Liu Na, Hu Qiqi, Xiong Yi, Zhang Liuyi
Medical College, Hunan Normal University, Changsha, China.
Department of Respiration, Sir Run Shaw Hospital, Zhejiang University, Hangzhou, China.
Gland Surg. 2022 Jun;11(6):1003-1014. doi: 10.21037/gs-22-243.
Microwave ablation (MWA) technology has been applied to the treatment of papillary thyroid microcarcinoma (PTMC); however, its use as an alternative to conventional open surgery (OS) remains controversial, because it belongs to non-tumor radical treatment. Our article sought to compare the efficacy and safety of MWA and OS in the treatment of PTMC.
We searched seven databases for studies evaluating the treatment of patients with PTMC using MWA as intervention group and OS as control group, the main outcome contained intra-operative, post-operative and follow-up outcomes. Review Manager 5.4 was used to estimate the effects of the results of the included articles and Cochrane Risk of Bias 2.0 was used to assess the risk of bias. The data were pooled to calculate the mean differences (MD) with 95% confidence intervals (CIs) for the continuous data and the odds ratio (OR) with 95% CIs for the dichotomous data.
A total of 13 studies, comprising 1,088 and 1,081 patients in the MWA and OS groups, respectively, were identified that compared the results of MWA to OS in the treatment of PTMC. All of the articles were at low risk of bias. There were no differences in terms of the recurrence rate (OR =0.80, 95% CI: 0.37 to 1.77; P=0.59) or lymph node metastasis (OR =0.71, 95% CI: 0.26 to 1.95; P=0.51) between the 2 groups. However, compared to the OS group, the MWA group had a shorter operation time (MD =-44.85, 95% CI: 5.73 to 20.68; P<0.00001), less intra-operative blood loss (MD =-23.37, 95% CI: -29.57 to -17.17; P<0.00001), a smaller surgical incision (MD =-47.04, 95% CI: -81.93 to -12.14; P=0.008), a shorter postoperative hospital stay (MD =-4.19, 95% CI: -5.46 to -2.92; P<0.00001), lower hospitalization expenses (MD =-85.65, 95% CI: -133.86 to -37.45; P<0.00001), and fewer complications (OR =0.23, 95% CI: 0.16 to 0.33; P<0.00001).
This meta-analysis suggests that MWA is better than OS at treating PTMC in terms of both intra-operative and post-operative outcomes. Due to the quality and number of the included studies, the long-term effects and suitability of MWA in the treatment of PTMC need to be further studied.
微波消融（MWA）技术已应用于甲状腺微小乳头状癌（PTMC）的治疗；然而，作为传统开放手术（OS）的替代方法，其应用仍存在争议，因为它属于非肿瘤根治性治疗。我们的文章旨在比较MWA和OS治疗PTMC的疗效和安全性。
我们检索了七个数据库，寻找以MWA为干预组、OS为对照组评估PTMC患者治疗情况的研究，主要结局包括术中、术后及随访结局。使用Review Manager 5.4估计纳入文章结果的效应，并使用Cochrane偏倚风险2.0评估偏倚风险。汇总数据以计算连续数据的平均差（MD）及95%置信区间（CI），以及二分数据的比值比（OR）及95%CI。
共识别出13项研究，MWA组和OS组分别有1088例和1081例患者，这些研究比较了MWA和OS治疗PTMC的结果。所有文章的偏倚风险均较低。两组在复发率（OR =0.80，95%CI：0.37至1.77；P=0.59）或淋巴结转移（OR =0.71，95%CI：0.26至1.95；P=0.51）方面无差异。然而，与OS组相比，MWA组手术时间更短（MD =-44.85，95%CI：5.73至20.68；P<0.00001），术中出血量更少（MD =-23.37，95%CI：-29.57至-17.17；P<0.00001），手术切口更小（MD =-47.04，95%CI：-81.93至-12.14；P=0.008），术后住院时间更短（MD =-4.19，95%CI：-5.46至-2.92；P<0.00001），住院费用更低（MD =-85.65，95%CI：-133.86至-37.45；P<0.00001），并发症更少（OR =0.23，95%CI：0.16至0.33；P<0.00001）。
这项荟萃分析表明，在术中及术后结局方面，MWA治疗PTMC优于OS。由于纳入研究的质量和数量，MWA治疗PTMC的长期效果和适用性需要进一步研究。
