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
ARTICLE HIGHLIGHTS
Research background

Patients diagnosed with solitary hepatocellular carcinoma (HCC) always receive liver resection. More and more patients are undergoing anatomical hepatectomy which aims to eradicate tumor. Accumulating studies had been performed to compare these two kinds of surgical technique. However, it is still not yet whether anatomical hepatectomy is superior to non-anatomical hepatectomy.

Research motivation

Clarifying the survival benefits of anatomical and non-anatomical hepatectomy is of vital importance for patients with solitary HCC. Furthermore, it will be instructive for doctors to choose better surgical method.

Research objectives

To perform a systematic review and meta-analysis on short- and long-term results of anatomical and non-anatomical hepatectomy in patients with solitary HCC.

Research methods

PubMed, Medline (Ovid), Embase (Ovid), and Cochrane Library were searched for articles from the inception of each database to 2020 according to the designed extraction scheme, and statistical analysis was performed using Cochrane Collaboration’s Review Manager 5.3 software. The quality of included papers was assessed with the modified Newcastle-Ottawa Scale. The main results of this study included overall survival (OS) and disease-free survival (DFS).

Research results

Fourteen studies (9444 patients) comparing anatomical and non-anatomical hepatectomy were included for final analysis with 4260 cases of anatomical resection (AR) and 5184 cases of non-anatomical resection (NAR). Anatomical hepatectomy was associated with a higher 5-year OS [odds ratio (OR): 1.10, 95% confidence interval (CI): 1.08-1.30] and DFS (OR: 1.26, 95%CI: 1.15-1.39). 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 between the two groups (OR: 1.24, P = 0.18).

Research conclusions

This meta-analysis confirmed that AR is superior to NAR in terms of long-term outcomes. Thus, AR can be recommended as a reasonable surgical approach in patients with solitary HCC.

Research perspectives

There are some limitations that should be taken into consideration when interpreting the results. The most vital limitation is that the included studies are non-randomized controlled trial and retrospective. Future studies with large-scale and well-designed randomized controlled trial are needed to further verify the benefits of anatomical hepatectomy for patients with solitary HCC.