Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2023; 15(2): 258-272
Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.258
Network meta-analysis of the prognosis of curative treatment strategies for recurrent hepatocellular carcinoma after hepatectomy
Jen-Lung Chen, Yaw-Sen Chen, Chen-Guo Ker
Jen-Lung Chen, Chen-Guo Ker, Department of General Surgery, E-Da Hospital, I-Shou University, Kaohsiung 824, Taiwan
Yaw-Sen Chen, Department of Surgery, School of Medicine, I-Shou University, Kaohsiung 824, Taiwan
Author contributions: Chen JL contributed to the research design, analysis, and manuscript revision; Chen YS contributed to the interpretation and conception; Ker CG contributed to the search and evaluation, analysis, and manuscript preparation.
Supported by the Research Fund from E-Da Hospital, No. EDAHS110012.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist statement, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist statement.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chen-Guo Ker, FACS, MD, PhD, Professor, Department of General Surgery, E-Da Hospital, I-Shou University, Yi-Da Road, Jian-Su Village, Yan-Chio District, Kaohsiung 824, Taiwan. ed112739@edah.org.tw
Received: September 26, 2022
Peer-review started: September 26, 2022
First decision: November 15, 2022
Revised: November 28, 2022
Accepted: January 16, 2023
Article in press: January 16, 2023
Published online: February 27, 2023
ARTICLE HIGHLIGHTS
Research background

Recurrent hepatocellular carcinoma (rHCC) is a common outcome after curative treatment. Retreatment for rHCC is controversial, and no guidelines are currently available.

Research motivation

Acceptable decision making for treatment of rHCC patients is a priority.

Research objectives

Our objectives were to conduct a network meta-analysis (NMA) to compare curative treatments including repeated hepatectomy (RH), radiofrequency ablation, transarterial chemoembolization (TACE), and liver transplantation (LT) for patients with rHCC after primary hepatectomy.

Research methods

There were 30 articles involving patients with rHCC after primary liver resection from 2011 to 2021 that were retrieved for this NMA.

Research results

The best-pooled outcomes of four retreatment methods were analyzed by multiple testing methods. In general, the LT subgroup had superior disease-free survival (DFS) (P < 0.001), whereas the RH subgroup had superior overall survival (OS) without significant differences compared to other treatments.

Research conclusions

RH and LT had better DFS and OS for rHCC than radiofrequency ablation and TACE. However, treatment strategies should be determined by the recurrent tumor characteristics, the patient’s general health status, and the care program of each institution.

Research perspectives

Retreatment with RH, LT, radiofrequency ablation, or TACE are determined by factors such as liver function, tumor burden, metastasis, vascular invasion, and others. A multiparametric evaluation should be in place for personalized treatment of patients with rHCC and re-evaluated in the future.