Aspiration versus Surgical Excision for Wrist Ganglion Cysts: A Systematic Review and Meta-analysis

Ganglion cysts are frequently encountered as benign soft-tissue lumps of the wrist. Treatments included observation, aspiration, and surgical excision. Although aspiration is less invasive, it often results in a high recurrence rate and shows no significant advantage over observation. Surgical excision is believed to offer better outcomes but involves greater invasiveness.

This study aims to systematically compare the rates of recurrence between aspiration and surgical excision for wrist ganglion cysts.

A comprehensive search of PubMed, Scopus, and ScienceDirect was conducted until April 2025. Eligible studies compared recurrence outcomes between aspiration and surgical excision in subjects with wrist ganglion cysts. Quality was assessed using the Risk of Bias 2.0 and ROBINS-I tools. Random effects were employed for analysis.

Nineteen studies with a total of 1,633 patients were included. Surgical excision resulted in a lower recurrence rate compared to aspiration (risk ratio [RR]: 0.46; 95% confidence interval [CI]: 0.30–0.69; I2  = 73%; p = 0.0002). Subgroup analysis confirmed the benefit of surgical excision in cohort studies and cases involving dorsal ganglia. However, the advantage was not statistically significant in randomized studies (RR: 0.34; 95% CI: 0.11–1.04; p = 0.06).

Surgical excision was associated with lower recurrence than aspiration, particularly in observational studies and dorsal wrist ganglia. However, this finding should be interpreted cautiously because the randomized subgroup was not statistically significant, and heterogeneity was substantial. These findings support tailored individualized treatment decisions.