Central Hepatectomy versus Major Hepatectomy for Patients with Centrally Located Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Abstract

Abstract Background Hepatocellular carcinoma (HCC) is the fifth-most common cancer globally and the third highest cause of cancer-related death exceeded only by cancers of the lung and stomach. It is estimated that 782,000 new cases are diagnosed with HCC annually and 600,000 die of this tumor globally each year. Therapeutic treatment modalities are available for patients with local disease including ablation, liver resection, and liver transplantation (LT). However, for those with respectable tumor and without an underlying liver disease, liver resection offers the best treatment. Aim of the Work The aim of this meta-analysis was to compare the short- and long- term outcomes including overall survival, recurrence rate and complications between patients treated with CH and patients treated with hemi-/extended hepatectomy for those with centrally located HCC. Patients and Methods A systematic review and meta-analysis, PubMed / MEDLINE, Scopes, Web of science, and the Cochrane Library were searched for data from inception to 1 April, 2022 with the following terms: major hepatectomy and Mesohepatectomy or central Hepatectomy and hepatocellular carcinoma. More searches by Google Scholar have been used to supplement the search with the sites mentioned above. according to the eligibility process. Abstract-based eligibility studies were obtained, and the manuscripts were fully reviewed. Report bibliographies that meet the eligibility criteria were reviewed for further studies. Results Our meta-analysis showed that the overall incidence of complications was comparable between the two modalities. However, on one hand, the incidence of post-operative liver cell failure was significantly higher in those who underwent major hepatectomy. This could be attributed to the fact that major hepatectomy is associated with the removal of 60–85% of liver parenchyma.6,7 On the other hand, a higher incidence of biliary fistula was detected for those who underwent central hepatectomy. Conclusion This study showed no significant difference in the short and long term survival and recurrence between CH and MH for CL-HCC. However, CH is associated with greater future remnant liver volume that decrease the incidence of LCF and provides more opportunities for a repeat hepatectomy after tumor recurrence.