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

doi:10.4251/wjgo.v13.i11.1833

Anatomical vs nonanatomical liver resection for solitary hepatocellular carcinoma: A systematic review and meta-analysis

World J Gastrointest Oncol. 2021 Nov 15;13(11):1833-1846. doi: 10.4251/wjgo.v13.i11.1833.

Authors

Hu Liu¹, Feng-Juan Hu², Hui Li¹, Tian Lan¹, Hong Wu³

Affiliations

¹ Department of Liver Surgery, Liver Transplantation Division, Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
² The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
³ Department of Liver Surgery, Liver Transplantation Division, Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. wuhong7801@163.com.

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: Anatomical resection; Hepatocellular carcinoma; Meta-analysis; Non-anatomical resection; Solitary tumor; Systematic review.