Irreversible Electroporation Versus Radiofrequency Ablation for Hepatic Malignancies: A Systematic Review and Meta-Analysis

The aim of this study was to systematically pool all direct comparative evidence from two-arm studies comparing irreversible electroporation (IRE) and radiofrequency ablation (RFA) for hepatic malignancies and evaluating local tumour recurrence/progression (LTRP), complication rates, and overall mortality. PubMed/MEDLINE, EMBASE, Web of Science, and the Cochrane Library were systematically searched from inception to April 30, 2026. Only studies with a direct IRE versus RFA comparison arm were eligible. Six direct comparative studies were included (two randomised controlled trials (RCTs) and four retrospective cohorts; n=623: IRE=258, RFA=365). Pooled analysis showed no significant difference between IRE and RFA in LTRP (RR 0.68, 95%CI 0.32-1.44; I2=64%; four studies), complication rates (RR 0.98, 95%CI 0.69-1.40; I2=0%; four studies), or mortality (RR 1.02, 95%CI 0.43-2.41; six studies). A consistent non-significant trend towards reduced LTRP with IRE was observed across studies. IRE demonstrates equivalent safety and a consistent, though statistically non-significant, trend towards superior local tumour control compared with RFA for hepatic malignancies. The high heterogeneity in LTRP and the limited number of studies preclude definitive conclusions. Larger, adequately powered RCTs with standardised endpoints are needed to definitively establish the comparative efficacy of IRE in this setting.