The Effectiveness of Decompression in Ameloblastoma Treatment: A Systematic Review and Meta-Analysis

BACKGROUND: There is a critical trade-off in ameloblastoma management: balancing the significant tissue-preserving benefits of decompression treatment against its potential for higher recurrence compared to radical resection. PURPOSE: The study purpose was to evaluate the therapeutic effects of decompression treatment for managing ameloblastoma. STUDY SELECTION: and Tau statistics. RESULTS: Nine studies met the inclusion criteria. The analysis included 555 ameloblastomas (381 unicystic ameloblastoma, 174 multicystic ameloblastoma). Decompression treatment yielded a significant mean size reduction of 55.3% (range: 7.5 to 93.02%). Recurrence outcomes were evaluated using time-to-event analysis where individual patient data were available (n = 287). The overall recurrence rate was 3.8 per 100 person-years (95% CI: 2.4 to 6.1). A stark difference was observed between histological subtypes: unicystic ameloblastoma demonstrated a recurrence rate of 2.1 per 100 person-years (95% CI: 1.1 to 4.0) compared to 8.9 per 100 person-years (95% CI: 5.4 to 14.6) for multicystic ameloblastoma (hazard ratio [HR] = 3.2; 95% CI: 1.8 to 5.7; P = .008). Longer decompression duration (>12 months) was associated with a significantly reduced recurrence hazard (HR = 0.52; 95% CI: 0.31 to 0.87; P = .012). Prolonged decompression (>12 months) was associated with a 48% reduction in recurrence hazard (HR = 0.52; 95% CI: 0.31 to 0.87; P = .012). CONCLUSIONS AND RELEVANCE: Decompression treatment is effective for reducing ameloblastoma size, facilitating minimally invasive treatment. However, recurrence risk is significantly higher in multicystic and mural subtypes, with multicystic variants demonstrating a 3.2-fold increased hazard of recurrence compared to unicystic variants. These findings support a tailored surgical approach based on histology and clinical presentation, though they should be interpreted with caution due to the high heterogeneity among the included studies.