Effectiveness of microwave ablation for the treatment of hepatic hemangioma - meta-analysis and meta-regression

Figures & data

Figure 1. Study flow diagram.

Table 1. Characteristics of pooled studies.

Studies no.	Authors and years	No. of patients	Study design	Tumor decreases after MWA (Mean ± SD, in diameter)		Tumor decreases in volume (%)	Hepatic aminotransferases		Major complications
				Pre-MWA	Post-MWA		ALT	AST
1	Yaoping S. 2020	82	MWA vs. TAE	6.9 ± 1.8	4.32 ± 1.45	N/A	273.5 ± 162.7	404.8 ± 256.4	Total of 8 with 2 cases of pleural effusion, 1 diaphragmatic hernia, 3 cases of acute renal dysfunction, 2 jaundice cases)
2	Libo C. 2019	94	Laparoscopic MWA vs. open resection	8.5 ± 2.1	4.3 ± 1.5	N/A	257.4 ± 84.7	352.2 ± 62.4	0
3	Xin L. 2019	Total of 58 with 25 in 3 D group and 33 in 2 D group	3D vs. 2 D	7.4 ± 1.5	N/A	52.1 ± 8.4	174.6 ± 91.1	181 ± 85.7	1 Acute kidney injury (AKI)
4	Xiaoyin T. 2019	112	MWA vs. Surgical resection	6.9 ± 1.5	N/A	N/A	269 ± 181.7	397.2 ± 257.3	Total of 4 with 1 diaphragmatic hernia, 3 cases of AKI
5	Fangyi L. 2018	20	Hemoglobinuria Group VS.	8.26 ± 1.92	N/A	52.14 ± 25.35	216.42 ± 189.54	313.71 ± 281.30	1 AKI
		29	Non-hemoglobinuria group	6.89 ± 1.48	N/A	53.97 ± 22.97	100.22 ± 61.70	145.73 ± 116.43	0
6	Zhi W. 2018	12	Retrospective study	11.6 ± 1.5	8.0 ± 1.5	N/A	267.7 ± 205.3	491.2 ± 336.3	2 cases of postoperative nonoliguric renal dysfunction
7	Fangyi L. 2017	40	US-guided percutaneous MWA	7.02 ± 1.55	N/A	59.67 ± 16.73	N/A	N/A	1 AKI
8	Xiaoyin T. 2015	46	Retrospective study	6.3 ± 1.4	N/A	N/A	N/A	N/A	Total of 5 with 2 cases of acute renal deficiency, 1 hyperbilirubinemia, 2 cases of symptomatic pleural effusion)
9	Timothy J. 2014	8	Retrospective study	5.5 ± 1.7	4.2 ± 1.2	49.75 ± 20.99	N/A	N/A	0
Studies no. & groups in studies			Ablation time (min)	Tumor size (centimeter)
1			32.2 ± 21.4	6.9 ± 1.8
2			26.7 ± 8.5	8.5 ± 2.1
3	3 D group		1152.0 ± 403.9 s	7.5 ± 1.7
	2D group		1379.7 ± 375.8 s	7.2 ± 1.3
4			31.3 ± 21.76	6.9 ± 1.5
5	Hemoglobinuria group		1506 ± 440.86 s	8.26 ± 1.92
	Non-hemoglobinuria group		1075 ± 529.82 s	6.89 ± 1.48
6			39 ± 14.36	11.6 ± 1.5
7			1175 ± 516 s	7.02 ± 1.55
8			15 ± 10	6.3 ± 1.4
9			11.62 ± 6.66	5.5 ± 1.7

Note: N/A: not available; s: seconds.

Figure 2. Tumor shrinkage after MWA treatment IN diameter (A) and IN volume (B). (Data in parentheses demonstrate 95% confidence intervals (CIs). The horizontal lines represent the 95% CIs, and the diamonds show the pooled effect sizes.)

Figure 3. Funnel plot assessing the publication bias in diameters.

Figure 4. Liver enzyme elevation. (a) ALT and (b) AST.

Figure 5. The pooled estimation of major complications incidences.

Figure 6. The association of pre-operative lesion diameter and ablation time.