Abstract
It remains unclear whether hepatectomy for colorectal liver metastasis (CRLM) should be performed as anatomical resection (AR) or nonanatomical resection (NAR). The aim of this study is to compare the short- and long-term outcomes of AR and NAR for CRLM. PubMed, Web of Science, EMBASE and the Cochrane Library were systematically searched to identify eligible studies. Twenty one studies involving 5207 patients were analyzed: 3034 (58.3%) underwent AR procedure and 2173 (41.7%) underwent NAR procedure. The results showed that overall survival (OS, hazard ratio (HR) 1.06, 95% confidence interval (CI) 0.95–1.18) and disease free survival (DFS, HR 1.11, 95% CI 0.99–1.24) did not differ significantly between AR and NAR. Duration of operation, postoperative morbidity and mortality were higher in AR than in NAR. There were no significant differences in blood loss and prevalence rate of postoperative positive margins (OR 0.79, 95% CI 0.37–1.52). Our analysis shows that AR does not seem to bring more prognostic benefits than NAR for the treatment of CRLM, and does seem to be inferior to NAR in terms of duration of operation, incidence of postoperative morbidity and mortality.
Highlights
Anatomical resection (AR)[9] for hepatocellular carcinoma (HCC), through a systematic removal of the liver parenchyma of one or more Couinaud’s segments fed by portal branches bearing the HCC, may reasonably reduce recurrence and return survival benefits compared to nonanatomical resection (NAR) or wedge resection
Based on the available data of some studies, the proportions of patients with carcinoembryonic antigen (CEA) level less than 200 ng/margin Blood loss (mL) and amounts of tumors were comparable in both groups
There was no evident publication bias based on Egger’s test (P = 0.32), with symmetry in Begg’s funnel plot (Fig. 6). This meta-analysis has broadly reviewed the differences of a variety of patient important outcomes between AR and NAR in performing hepatectomy for colorectal liver metastasis (CRLM)
Summary
Anatomical resection (AR)[9] for hepatocellular carcinoma (HCC), through a systematic removal of the liver parenchyma of one or more Couinaud’s segments fed by portal branches bearing the HCC, may reasonably reduce recurrence and return survival benefits compared to nonanatomical resection (NAR) or wedge resection. A widely accepted survival superiority of AR has been confirmed by several large cohort studies and meta-analyses[10,11,12,13,14,15,16,17]. Whether an analogical survival superiority can be achieved by AR for CRLM in comparison with NAR remains unclear. Several reports[19,20,21] have documented long-term survival benefits of AR procedure for CRLM over NAR procedure, whereas other reports[22,23,24,25] have failed to demonstrate such benefits, with results showing equivalent five-year overall survival (OS) rate between the two procedures. A meta-analysis of all available studies comparing the efficacy (short- and long-term outcomes) of AR procedure and NAR procedure for CRLM was conducted to get more reliable and up-to-date evidence
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