Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2017; 23(44): 7917-7929
Published online Nov 28, 2017. doi: 10.3748/wjg.v23.i44.7917
Anterior vs conventional approach right hepatic resection for large hepatocellular carcinoma: A systematic review and meta-analysis
Jian-Xin Tang, Jin-Jun Li, Rui-Hui Weng, Zi-Ming Liang, Nan Jiang
Jian-Xin Tang, Jin-Jun Li, Zi-Ming Liang, Nan Jiang, Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yatsen University, Guangzhou 510630, Guangdong Province, China
Rui-Hui Weng, Department of Neurology, The Third Affiliated Hospital of Sun Yatsen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Tang JX and Li JJ acquired, analyzed and interpreted the data; Tang JX drafted the article; Weng RH revised the article; Liang ZM interpreted the data; Jiang N conceived and designed the study and critically revised the manuscript; all authors have read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81572368; the Guangdong Natural Science Foundation, No. 2016A030313278; and the Science and Technology Planning Project of Guangdong Province, China, No. 2014A020212084.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Nan Jiang, MD, PhD, Department of Hepatic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China. njiang163@163.com
Telephone: +86-20-85252177 Fax: +86-20-85252276
Received: August 14, 2017
Peer-review started: August 15, 2017
First decision: August 30, 2017
Revised: September 16, 2017
Accepted: September 19, 2017
Article in press: September 19, 2017
Published online: November 28, 2017
Processing time: 104 Days and 11.8 Hours
Abstract
AIM

To compare the clinical outcomes of right hepatectomy for large hepatocellular carcinoma via the anterior and conventional approach.

METHODS

We comprehensively performed an electronic search of PubMed, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) or controlled clinical trials (CCTs) published between January 2000 and May 2017 concerning the anterior approach (AA) and the conventional approach (CA) to right hepatectomy. Studies that met the inclusion criteria were included, and their outcome analyses were further assessed using a fixed or random effects model.

RESULTS

This analysis included 2297 patients enrolled in 16 studies (3 RCTs and 13 CTTs). Intraoperative blood loss [weighted mean difference = -255.21; 95% confidence interval (95%CI): -371.3 to -139.12; P < 0.0001], intraoperative blood transfusion [odds ratio (OR) = 0.42; 95%CI: 0.29-0.61; P < 0.0001], mortality (OR = 0.59; 95%CI: 0.38-0.92; P = 0.02), morbidity (OR = 0.77; 95%CI: 0.62-0.95; P = 0.01), and recurrence rate (OR = 0.62; 95%CI: 0.47-0.83; P = 0.001) were significantly reduced in the AA group. Patients in the AA group had better overall survival (hazard ratio [HR] = 0.71; 95%CI: 0.50-1.00; P = 0.05) and disease-free survival (HR = 0.67; 95%CI: 0.58-0.79; P < 0.0001) than those in the CA group.

CONCLUSION

The AA is safe and effective for right hepatectomy for large hepatocellular carcinoma and could accelerate postoperative recovery and achieve better survival outcomes than the CA.

Keywords: Anterior approach; Conventional approach; Right hepatectomy; Hepatocellular carcinoma; Postoperative complication; Survival

Core tip: Anterior approach has been suggested as an alternative approach to conventional approach for right hepatectomy. However, comparative studies have shown conflicting results. To evaluate whether right hepatectomy using the anterior approach for large hepatocellular carcinoma results in better clinical outcomes when compared with the conventional approach, we investigated these two techniques in terms of estimated intraoperative blood loss, massive blood loss, intraoperative blood transfusion, operative time, mortality, morbidity, recurrence rate, hospital stay, overall survival and disease-free survival.