Percutaneous thermal ablation exhbits near-Zero Mortality, 3 Percent Complication Rate in small malignant liver tumors: Meta-Analysis
France: A recent meta-analysis published in Radiology has reaffirmed the strong safety profile of percutaneous thermal ablation (PTA) for the treatment of small malignant liver tumors, reporting an extremely low mortality rate and a consistently low incidence of major complications.
The study, led by Dr. Gary Doppelt from Caremeau University Hospital, France, evaluated procedure-related risks associated with PTA techniques, including radiofrequency and microwave ablation. These minimally invasive approaches are widely used for treating small liver malignancies, particularly when surgery may not be feasible. While earlier studies have supported their safety, reported complication rates have varied, prompting the need for updated and standardized benchmarks.
To address this, the researchers performed a systematic review and single-proportion meta-analysis of prospective randomized and cohort studies published between January 2007 and September 2022. Major medical databases, including MEDLINE, Embase, and Cochrane, were searched to identify relevant studies. The analysis focused on patients undergoing ablation for up to three liver tumors measuring 5 cm or less, with a minimum follow-up duration of 90 days.
A total of 49 studies met the inclusion criteria, encompassing 4,149 patients and 4,636 ablation procedures. Two independent reviewers conducted study selection, data extraction, and bias assessment to ensure methodological rigor. The primary outcome assessed was the rate of significant adverse events, defined as grade C to E complications according to the Society of Interventional Radiology classification, as well as procedure-related mortality within 90 days.
The researchers reported the following findings:
- Major adverse events were reported in approximately 3% of patients.
- Only one procedure-related death occurred across all studies, reflecting a mortality rate of 0.01%.
- The findings indicate a near-zero risk of death associated with the procedure.
- No significant difference in complication rates was observed between radiofrequency and microwave ablation.
- Adverse event rates were similar in patients with hepatocellular carcinoma and those with metastatic liver tumors.
- The results highlight a consistent safety profile of percutaneous thermal ablation across different techniques and tumor types.
The authors emphasized that their results establish a robust and contemporary benchmark for procedural safety in liver ablation. They also highlighted the advantages of PTA compared with surgical interventions, noting that previously reported postoperative complication rates range from 17% in minimally invasive surgery to as high as 31% in open procedures.
In their conclusion, the researchers described PTA as a low-risk and reliable treatment option that continues to play a central role in the multidisciplinary management of liver malignancies. They also called for future prospective studies with standardized definitions and reporting of adverse events to further refine safety assessments and better capture less frequently reported complications.
An accompanying editorial by Dr. Michael Bettmann from Wake Forest University described the analysis as a valuable effort to establish a meaningful safety baseline. He also noted that ongoing advancements in ablation technologies and combination therapies are likely to further enhance outcomes, reinforcing the procedure’s growing importance in cancer care.
Reference:
Doppelt G, Occéan BV, Fabbro-Peray P, Haefliger L, Tardieu L, Schembri V, Minier C, Hermida M, Pierredon Foulongne MA, Belgour A, Frandon J, Escal L, Allimant C, Piron L, Guiu B. The Safety Standards for Liver Percutaneous Thermal Ablation: A Meta-Analysis of Adverse Events over 15 Years. Radiology. 2026 Mar;318(3):e251517. doi: 10.1148/radiol.251517. PMID: 41874301.
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