Efficacy and safety of radiofrequency ablation versus surgery for management of papillary thyroid microcarcinoma: a systematic review, meta-analysis, and meta-regression

Introduction:
The current evidence is ambiguous regarding the comparative efficacy and safety of radiofrequency ablation (RFA) versus surgery as thera­peutic options for papillary thyroid microcarcinoma (PTMC). The principal aim of this study was to clarify these uncertainties.

Material and methods:
A thorough investigation was performed using the Cochrane Library, Europe PMC, Scopus, and Medline databases until January 20^th, 2025, employing a combination of pertinent keywords. This review included studies that compared RFA and surgery for PTMC. We employed random-effects models to assess the mean difference (MD) and odds ratio (OR) for the reported outcomes.

Results:
A total of 7 studies with 1,638 patients were included. Our meta- analysis indicated that RFA was associated with a shorter procedure time (MD –62.69 min; 95% CI: –78.33, –47.05, p < 0.00001), less blood loss (MD –24.13 ml; 95% CI: –30.02, –18.23, p < 0.00001), shorter hospitalization duration (MD –6.70 days; 95% CI: –8.85, –4.55, p < 0.00001), and lower total expenses (SMD –2.77; 95% CI: –4.27, –1.27, p = 0.0003) compared to surgery in PTMC patients. No significant difference in the tumor progression rate (p = 0.80), lymph node metastasis (p = 0.24), or recurrence rate (p = 0.38) was observed between RFA and surgery. In terms of safety, RFA exhibited fewer total complications (OR 0.33; 95% CI: 0.13–0.80, p = 0.01) than surgery.

Conclusions:
RFA may serve as a feasible alternative for the treatment of PTMC in individuals who have opted against active surveillance or are ineligible for surgical intervention.