Efficacy and Safety of Radiofrequency Ablation Versus Video-assisted Thoracoscopic Sympathectomy in Palmar Hyperhidrosis: A Multicenter Cohort Study

Abstract Background: Radiofrequency ablation (RFA) was adopted as an alternative to surgical options for sympathectomy in patients with palmar hyperhidrosis (PHH), but the RFA comparative efficacy of treatments by video-assisted thoracoscopic sympathectomy (VATS) on long-term remains uncertain.Methods: We recruited patients aged ≥14 years with diagnosed PHH from 14 centers in China. The treatment options of RFA or VATS were recruited in patient with informed consent. The primary outcome was the clinical efficacy in 1-year. Propensity scoring and multivariable models respectively were used to evaluate the clinical efficacy and inefficacy risk of treatment options.Results: A total of 807 patients were enrolled, 351 patients underwent RFA, and 456 were VATS. After propensity score matching, the rate of complete remission was lower in RFA than in VATS (79.2% [247/312] versus 91.3% [285/312], 95% confidence intervals [CI] 0.21 to 0.57, p<0.001). However, the rate of palmar dryness (95% CI 0.38 to 0.92, p=0.020), of postoperative pain (95% CI 0.13 to 0.33, p<0.001), and of surgical-related complication (95% CI 0.19 to 0.85, p=0.020) is lower in RFA group than in VATS group, and radiofrequency ablation group of skin temperature rise is more common (95% CI 1.84 to 3.58, p<0.001).Conclusion: Performing RFA had a lower success rate than VATS for the complete remission of palmar hyperhidrosis. However, RFA may be better reasonable treatment option for palmar hyperhidrosis before surgical sympathectomy, because it more possibly accepted and generalized due to lower symptomatic burden and costs than surgical sympathectomy in patients.Trial RegistrationChiCTR2000039576, URL: http://www.chictr.org.cn/index.aspx