This systematic review and meta-analysis examined the safety, technical success, and long-term oncological outcomes of minimally invasive surgical thermal ablation (MITA) in patients with liver malignancies. The study population comprised 3983 patients treated with MITA, which includes both laparoscopic and robotic approaches. The analysis compared outcomes against the context of percutaneous approaches, highlighting the advantages of the surgical route for certain anatomical locations. Data were pooled from multiple studies with a median follow-up of 60.0 months.
Regarding technical success and safety, the meta-analysis reported an overall technical failure rate of 2%, with a 95% confidence interval (CI) of 1-4%. Studies published after 2017 demonstrated a significant improvement, showing a technical failure rate of 1%. Major complications, defined as Clavien-Dindo grade 3a or higher, occurred in 2.2% of patients (95% CI 1.4-3.5%). The 30-day mortality rate was low at 0.25% (95% CI 0.08-0.75%). The review noted very low procedure-related morbidity and mortality overall, though specific adverse events were not reported in detail.
Oncological outcomes varied by cancer type and follow-up duration. For hepatocellular carcinoma, one-year overall survival (OS) was 90%, declining to 69% at three years and 45% at five years. Corresponding disease-free survival (DFS) rates were 74% at one year, 48% at three years, and 29% at five years. In patients with colorectal liver metastases, one-year OS was 90%, dropping to 60% at three years and 43% at five years. Disease-free survival for this group was 66% at one year, 60% at three years, and 43% at five years. Local tumor progression was observed at a rate of 6.13 events per 100 person-years.
These results suggest that MITA offers a safe alternative for tumors unsuitable for percutaneous treatment, particularly when percutaneous access is difficult. The technical success rates are high, and the safety profile is favorable with low mortality. However, the data indicate that high technical success does not always translate into durable local control, as evidenced by the progression rates and declining survival curves over time. The review highlights that while immediate procedural success is high, long-term efficacy requires further investigation.
Several methodological limitations affect the interpretation of these findings. The primary limitation is heterogeneous reporting standards across the included studies, which can introduce bias and reduce the precision of pooled estimates. Additionally, there is limited evidence regarding durable local control despite the high rates of technical success. The lack of standardized outcome definitions across studies further complicates direct comparisons. Funding sources and potential conflicts of interest were not reported for the included studies.
Clinically, this evidence supports the consideration of MITA for patients with liver malignancies where percutaneous approaches are not feasible. The low 30-day mortality and manageable complication rates support its use in specialized centers. However, the declining long-term survival and disease-free survival rates suggest that MITA may not be a definitive cure for all patients, and expectations should be managed accordingly. Multicenter randomized controlled trials with standardized outcome definitions are needed to refine practice guidelines and clarify the role of MITA in the broader treatment landscape.
Several questions remain unanswered regarding the optimal patient selection criteria for MITA versus other modalities. The long-term durability of local control needs further validation in larger, prospective cohorts. Additionally, the specific subgroups of patients who derive the most benefit from the surgical approach versus percutaneous methods require more granular analysis. Until these questions are addressed, clinicians should weigh the immediate procedural benefits against the potential for local recurrence when counseling patients.
In conclusion, this systematic review provides robust evidence that minimally invasive surgical thermal ablation is a safe and technically successful option for treating liver malignancies. The data demonstrate low mortality and complication rates, with technical success improving in recent years. However, the evidence regarding long-term oncological control is mixed, with local tumor progression occurring in a notable number of cases. Practitioners should consider these limitations when integrating MITA into treatment plans, reserving it primarily for cases where percutaneous options are contraindicated or technically unfeasible.
