Comparison of US-guided thermal ablation and surgery for papillary thyroid cancer: a systematic review and meta-analysis.

[OBJECTIVE] We conducted the systematic review and meta-analysis to comprehensively compare ablation and surgery in terms of effectiveness, safety and multiple factors affecting life quality of patients with papillary thyroid cancer (PTC).

[METHODS] PubMed, Embase, Scopus, Web of Science and EBSCO were searched for relevant studies published between January 1980 and September 2023. Two reviewers independently extracted data according to the PRISMA recommendations and assessed the quality of each study with the Cochrane Risk of Bias Tool. Pooled analyses were performed using random or fixed-effects models, as appropriate.

[RESULTS] A total of 4829 patients with PTC from 19 eligible studies were included. Through the meta-analysis, similar tumor progression (OR: 1.07; 95% CI 0.78, 1.48;  = 0.66) and recurrence-free survival (OR: 0.86; 95% CI, 0.55, 1.34;  = 0.50) were found between the patients undergoing ablation and those undergoing surgery. More strikingly, the lower risk of major complications (OR: 0.31; 95% CI 0.24, 0.41;  < 0.001), the shorter hospital stay (MD = 3.67 d; 95% CI, -4.89, -2.44;  < 0.001), the abbreviated procedure time (MD: -66.33 min, 95% CI, -77.08, -55.59;  < 0.001), the less intraoperative blood loss (MD: -27.43 ml, 95% CI, -34.60, -20.27;  < 0.001) and the lower treatment cost (MD: -860.42 USD, 95% CI, -1008.03, -712.81;  < 0.001) were noticed in ablation techniques compared to surgical operation. Thermal ablation has shown multiple advantages by virtue of its percutaneous puncture compared with surgical resection.

[CONCLUSION] As an effective, safe, minimally invasive and economical modality, thermal ablation might be a promising alternative to existing PTC management options.