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.
Highlights
Thermal ablation therapy is a validated curative-intended treatment option for malignant liver tumors, mainly hepatocellular carcinoma (HCC) and liver metastases from colorectal cancer (CRLM) [1, 2]
After screening a total of 1,412 articles, 93 original works published in English and reporting on a minimum of 10 patients treated with stereotactic or robotic thermal ablation for malignant liver tumors were included for full-text screening
After additional exclusion of 59 works, 34 articles were included for qualitative analysis and 22 for quantitative analysis (Figure 1)
Summary
Thermal ablation therapy is a validated curative-intended treatment option for malignant liver tumors, mainly hepatocellular carcinoma (HCC) and liver metastases from colorectal cancer (CRLM) [1, 2]. Following encouraging oncological outcome results for small tumors in the setting of limited disease, thermal ablation has been introduced into international treatment guidelines for both HCC and CRLM [3, 4]. For lesions remaining invisible due to small size, deep central location, obstructing gas/ ribs, or changes in liver parenchyma [10], computed tomography (CT) or magnetic resonance (MR) guidance enhances visibility but introduces constraints due to radiation exposure [11] or procedurerelated complexity. Stereotactic 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
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