Comparison of Radiofrequency Ablation (RFA) Versus Video-Assisted Thoracoscopic Sympathectomy (VATS) for Primary Hyperhidrosis: A Multicenter Cohort Study

Background: Hyperhidrosis may affect approximately a hundred million global people; lead to they may be socially stigmatized. We hypothesized that radiofrequency ablation (RFA) and video-assisted thoracoscopic sympathectomy (VATS) would be equivalent in the treatment for primary hyperhidrosis (PH). Methods: In this multicenter cohort study, we recruited patients aged ≥14 years with diagnosed PH from 14 centers in China. The treatment options of RFA or VATS were recruited in patient with informed consent. Clinical effectiveness of treatment was assessed in patients the day of hospital discharge and on the time of study endpoint. Hyperhidrosis Disease Severity Scale (HDSS) and quality of life (QOL) were assessed in patients the day before operative and on the time of study endpoint. The primary endpoint was the rate of complete remission for hyperhidrosis. Propensity scoring and multivariable models respectively were used to assess the clinical effectiveness and the symptom recurrence risk of treatment options. Findings: Between March 4, 2015, and Sept 31, 2020, 807 patients were enrolled in our study. 351 of these patients underwent RFA, and 456 were VATS. After propensity score matching, the rate of complete remission was lower in RFA than in VATS (287/351[80.3%] versus 319/351 [90.1%], standardized mean differences, -30.4%). We did find the rate of symptom recurrence risk was higher in RFA than in VATS (HR 2.315, 95%CI 1.511-3.546, P <0.0001). HDSS and QOL were significantly improved in postoperative than in preoperative for two groups, however, it was more significant improvement in VATS than in RFA (p<0.0001). Interpretation: This study suggested that performing RFA or VATS was significant success procedure for patients with PH. However, the RFA had a lower success rate than VATS for complete remission of hyperhidrosis in postoperative 1-year, but it is more possibly accepted due to lower symptomatic burden and costs in patients. Funding Statement: This work was supported by the National Natural Science Foundation of China (No. 81671957, 81873951 and 82072208), Key projects of Guangdong Natural Science Foundation (No. 2018B030311038). Declaration of Interests: The writing committee declares that they have no conflicts of interest. Ethics Approval Statement: The study was approved by institution ethics committees at principal investigator centers. All patient’s follow-up provided written informed consent before inclusion. The study was done in accordance with the Declaration of Helsinki and Good Clinical Practice principles.