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Abstract
BackgroundThe surgical decision of performing anatomic resection (AR) or nonanatomic resection (NAR) in patients with hepatocellular carcinoma remains controversial. The aim of the current study is to conduct a meta-analysis on published results to compare surgical outcomes after AR and NAR.MethodsA comprehensive search of the Pubmed, Ovid-Medline, Embase, Cochrane library, and Science Citation indexes was performed. Overall and disease free survival (DFS), perioperative mortality and morbidity were the main outcomes. The meta-analysis was performed using Revman 5.3 statistical software, and the results are expressed as the relative risk (RR) or weighted mean differences with 95% of confidence intervals.ResultsAfter application of the exclusion and inclusion criteria, 25 studies published between 1996~2015 that compared outcomes after AR and NAR in patients with HCC were identified. A total of 10216 patients were included in the meta-analysis, 4576 in the AR group and 5640 in the NAR group. Liver cirrhosis was found in 54.8% (range from 18.8% to 100%) of patients in the AR group and 67.8% (range from 34.3% to 100%) of patients in the NAR group, resulting in a RR of 0.45 (I2 = 18%, fixed model, 95% CI 0.39–0.52; Z = 10.31; P = <0.00001). The meta-analysis revealed a statistically significant 5-year survival (RR of 1.10, 95% CI 1.03–1.17; Z = 2.92, P = 0.004) and DFS (RR: 1.33, 95% CI 1.18–1.51; Z = 4.46, P <0.00001) advantage for patients undergoing AR resection compared to NAR. In regards to safety, no statistical significance was found in mortality and morbidity between the two groups. Eight studies including 1812 patients with small (<5 cm) solitary HCC indicated a better 5-year DFS in the AR group (41.4%) than in the NAR group (28.6%), with a RR of 1.32 (I2 = 42, fixed model, 95%CI: 1.15–1.52, Z = 3.86, P = 0.0001).ConclusionThe current study demonstrates better surgical outcomes after AR than NAR in patients with HCC. Therefore, AR is recommended in resectable HCC, especially with small (<5 cm) solitary tumours.
Highlights
Hepatocellular carcinoma (HCC) is the one of the most common malignant cancers worldwide[1], and its incidence continues to rise because of various risk factors, hepatitis induced cirrhosis and non-alcoholic steatohepatitis (NASH)[2,3,4]
Liver cirrhosis was found in 54.8% of patients in the anatomic resection (AR) group and 67.8% of patients in the nonanatomic resection (NAR) group, resulting in a relative risk (RR) of 0.45 (I2 = 18%, fixed model, 95% confidence intervals (CIs) 0.39–0.52; Z = 10.31; P =
The meta-analysis revealed a statistically significant 5-year survival (RR of 1.10, 95% CI 1.03–1.17; Z = 2.92, P = 0.004) and disease free survival (DFS) (RR: 1.33, 95% CI 1.18–1.51; Z = 4.46, P
Summary
Hepatocellular carcinoma (HCC) is the one of the most common malignant cancers worldwide[1], and its incidence continues to rise because of various risk factors, hepatitis induced cirrhosis and non-alcoholic steatohepatitis (NASH)[2,3,4]. Conventional limited resection, nonanatomic resection (NAR), is focused on achieving a non-tumoural liver parenchyma rim, without consideration of the Glisson’s pedicles[8, 9]s. Because of the underlying liver diseases of most patients with hepatocellular carcinoma, such as chronic hepatitis and cirrhosis, NAR is regarded to be useful for retaining as much liver parenchyma as possible[10]. This technique is extremely significant in patients with cirrhosis because the cirrhotic liver has a very limited capacity to regenerate [11], which is closely related to the long-term prognosis.
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