Central hepatectomy versus major hepatectomy for patients with centrally located hepatocellular carcinoma: a systematic review and meta-analysis

Edward Atef Gadallah; Beshoy Effat Elkomos; Ahmed Khalil; Fawzy Salah Fawzy; Amr Abdelaal

doi:10.1186/s12893-022-01891-7

Central hepatectomy versus major hepatectomy for patients with centrally located hepatocellular carcinoma: a systematic review and meta-analysis

BMC Surg. 2023 Jan 5;23(1):2. doi: 10.1186/s12893-022-01891-7.

Authors

Edward Atef Gadallah¹, Beshoy Effat Elkomos², Ahmed Khalil¹, Fawzy Salah Fawzy¹, Amr Abdelaal¹

Affiliations

¹ General Surgery Department, Ain Shams University Hospital, Cairo, Egypt.
² General Surgery Department, Ain Shams University Hospital, Cairo, Egypt. Beshoyafet0100304@med.asu.edu.eg.

Abstract

Background and aim: For those with a centrally located HCC, the two types of liver sectionectomy that can be performed are extended hepatectomy (EH) and central hepatectomy (CH). This meta-analysis aimed to compare the short- and long-term outcomes between patients treated with CH and patients treated with EH for those with centrally located HCC.

Method: We searched PubMed, Scopus, Web of Science, and Cochrane library for eligible studies from inception to 1 April 2022 and a systematic review and meta-analysis were done to compare the outcomes between the two groups.

Results: we included 9 studies with a total of 1674 patients in this study. The pooled results in this meta-analysis showed equal long-term overall survival, Disease-free survival, recurrence and mortality between the two groups (5-year OS, RR = 1.14, 95% CI = 0.96-1.35, P = 0.12; I² = 56%), (5-year DFS, RR = 0.81, 95% CI = 0.61-1.08, P = 0.15; I² = 60%), (Recurrence, RR = 1.04, 95% CI = 0.94-1.15, P = 0.45; I² = 27%), and (Mortality, RR = 0.55, 95% CI = 0.26-1.15, P = 0.11; I² = 0%). In addition to that, no significant difference could be detected in the overall incidence of complications between the two groups (Complications, RR = 0.94, 95% CI = 0.76-1.16, P = 0.57; I² = 0%). However, CH is associated with a remarkable increase in the rate of biliary fistula (Biliary fistula, RR = 1.90, 95% CI = 1.07-3.40, P = 0.03; I² = 0%). And Liver cell failure was higher in the case of EH (LCF, RR = 0.47, 95% CI = 0.30-0.76, P = 0.002; I² = 0%). Regarding the operative details, CH is associated with longer operative time (Time of the operation, Mean difference = 0.82, 95% CI = 0.36, 1.27, P = 0.0004; I² = 57%).

Conclusion: 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 decreases the incidence of LCF and provides more opportunities for a repeat hepatectomy after tumour recurrence.

Keywords: Centrak hepatectomy; Centrally located HCC; Hepatocellular carcinoma; Major hepatectomy.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Biliary Fistula* / etiology
Carcinoma, Hepatocellular* / pathology
Hepatectomy / methods
Humans
Liver Neoplasms* / pathology
Neoplasm Recurrence, Local / surgery
Treatment Outcome