Abstract
To compare the outcomes of microwave ablation (MWA) vs. cryoablation (CA) for T1a renal masses. A review of literature for studies from MEDLINE and EMBASE from 2005 to 2019 was performed without language restrictions. Inclusion criteria were 1- stage T1a renal cell carcinoma (RCC), 2- use of CA or MWA percutaneously, 3- case series or retrospective studies with >15 patients and, 4- reported outcomes of local recurrence, overall survival (OS) and complications. When available, complications were quantified for MWA and CA for each study. When recurrence rates or complication rates or OS were not included in a study, that study population was not included in the relevant calculations. Studies with overlapping populations were excluded. The analysis was carried SPSS software. For categorical variables, counts or proportions were extracted from each study and merged. For continuous variables means and standard deviations were extracted and merged. We used the chi-square test for analyzing baseline characteristics of patients. Complications and recurrences were calculated as odds ratios with 95% confidence intervals. A test of heterogeneity of included studies was conducted, sensitivity analysis and publications bias were also done. A total of 29 studies (12 MWA and 17 CA) met the inclusion criteria with overall 3763 patients (3139 patients in CA and 624 patients in MWA). The pooled proportion of patients for recurrence was 1270 patients (898patients in CA and 372 patients in MWA) and 1523 patients for complications (1106 CA and 417 MWA). For 2-year OS, 2054 patients were included in analysis (1932 for CA and 122 for MWA). In the pooled results, complication rates were not statistically significantly different between CA (11.8%) and MWA (12.0%) (OR: 0.99 95% CI = 0.705-1.410 P = 0.876). The local recurrence rate was 10.5% for CA vs. 5.9% for MWA which was statistically significant (OR: 0.53 95%CI = 0.332-0.870 P = 0.01). There was a difference in 2 years OS between CA (73%) versus MWA (93.4%) (OR: 0.19 95% CI: 0.092-0.393 P = 0.0001). In our meta-analysis, MWA and CA did not show a difference in complications, but local recurrence was lower with MWA and 2-year survival was better.
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