Radiofrequency Ablation for Papillary Thyroid Carcinoma versus Surgery and Other Thermal Ablation Techniques: A Systematic Review and Meta-Analysis of Outcomes

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Background: Radiofrequency ablation (RFA) has been proposed for selected patients with low-risk papillary thyroid carcinoma (PTC). This study compared the effectiveness, safety, and procedural characteristics of RFA with those of surgery and other thermal ablation techniques. Methods: PubMed, Embase, Cochrane, and KoreaMed were searched for studies published between January 2000 and March 2025. Two reviewers independently extracted data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessed study quality using the Risk of Bias Assessment Tool for Nonrandomized Studies, version 2. Pooled analyses were performed using random-effects models. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for dichotomous outcomes, and mean differences (MDs) were calculated for continuous outcomes. Results: Fifteen studies including 3,612 patients with PTC were analyzed. Compared with surgery, RFA was associated with a similar disease progression rate (OR, 0.91; 95% CI, 0.55 to 1.51; P=0.683) and a lower complication rate (OR, 0.35; 95% CI, 0.20 to 0.63; P=0.003). RFA was also associated with less intraoperative blood loss (MD, -21.87 mL), shorter procedure time (MD, -68.14 minutes), and shorter hospital stay (MD, -5.75 days; all P<0.001). Compared with other thermal ablation techniques, RFA showed similar disease progression rates (OR, 1.05; 95% CI, 0.16 to 7.14), complication rates (OR, 0.88; 95% CI, 0.17 to 4.49), volume reduction rates (MD, 0.02%), and complete disappearance rates (MD, 0.96%), with no statistically significant differences across outcomes. Conclusion: RFA may be considered as an alternative to surgery for selected patients with low-risk PTC. Randomized trials with longer follow-up are needed to confirm its oncologic durability and safety.