Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2021; 13(11): 1833-1846
Published online Nov 15, 2021. doi: 10.4251/wjgo.v13.i11.1833
Anatomical vs nonanatomical liver resection for solitary hepatocellular carcinoma: A systematic review and meta-analysis
Hu Liu, Feng-Juan Hu, Hui Li, Tian Lan, Hong Wu
Hu Liu, Hui Li, Tian Lan, Hong Wu, Department of Liver Surgery, Liver Transplantation Division, Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Feng-Juan Hu, The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Liu H and Wu H contributed to the design of this study; Liu H and Hu FJ collected the clinical data; Liu H, Li H, and Lan T contributed to data analysis; Liu H and Hu FJ performed the statistical analysis; all the authors participated in drafting the manuscript; Liu H, Hu FJ, and Li H revised the manuscript; all the authors approved the final version of the manuscript.
Supported by National Key Technologies RD Program, No. 2018YFC1106803; National Natural Science Foundation of China, No. 81872004, No. 81770615, and No. 81672882; and Science and Technology Support Program of Sichuan Province, No. 2019YFQ0001 and No. 2017SZ0003.
Conflict-of-interest statement: The authors deny any conflict of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong Wu, MD, PhD, Doctor, Professor, Surgeon, Department of Liver Surgery, Liver Transplantation Division, Laboratory of Liver Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. wuhong7801@163.com
Received: January 14, 2021
Peer-review started: January 14, 2021
First decision: May 3, 2021
Revised: May 8, 2021
Accepted: July 13, 2021
Article in press: July 13, 2021
Published online: November 15, 2021
Abstract
BACKGROUND

The long-term survival of patients with solitary hepatocellular carcinoma (HCC) following anatomical resection (AR) vs non-anatomical resection (NAR) is still controversial. It is necessary to investigate which approach is better for patients with solitary HCC.

AIM

To compare perioperative and long-term survival outcomes of AR and NAR for solitary HCC.

METHODS

We performed a comprehensive literature search of PubMed, Medline (Ovid), Embase (Ovid), and Cochrane Library. Participants of any age and sex, who underwent liver resection, were considered following the following criteria: (1) Studies reporting AR vs NAR liver resection; (2) Studies focused on primary HCC with a solitary tumor; (3) Studies reporting the long-term survival outcomes (> 5 years); and (4) Studies including patients without history of preoperative treatment. The main results were overall survival (OS) and disease-free survival (DFS). Perioperative outcomes were also compared.

RESULTS

A total of 14 studies, published between 2001 and 2020, were included in our meta-analysis, including 9444 patients who were mainly from China, Japan, and Korea. AR was performed on 4260 (44.8%) patients. The synthetic results showed that the 5-year OS [odds ratio (OR): 1.19; P < 0.001] and DFS (OR: 1.26; P < 0.001) were significantly better in the AR group than in the NAR group. AR was associated with longer operating time [mean difference (MD): 47.08; P < 0.001], more blood loss (MD: 169.29; P = 0.001), and wider surgical margin (MD = 1.35; P = 0.04) compared to NAR. There was no obvious difference in blood transfusion ratio (OR: 1.16; P = 0.65) or postoperative complications (OR: 1.24, P = 0.18).

CONCLUSION

AR is superior to NAR in terms of long-term outcomes. Thus, AR can be recommended as a reasonable surgical option in patients with solitary HCC.

Keywords: Hepatocellular carcinoma, Anatomical resection, Non-anatomical resection, Meta-analysis, Systematic review, Solitary tumor

Core Tip: Anatomical hepatectomy is considered an effective way to treat hepatocellular carcinoma (HCC) in theory. However, there is still no consensus about which surgical technique between anatomical and non-anatomical hepatectomy is more suitable for patients with solitary HCC. This study aimed to compare the long-term survival outcomes between anatomical and non-anatomical hepatectomy in HCC patients undergoing curative resection. Patients with a solitary tumor undergoing AR were associated with a better overall survival.