Lee AJ, Wu AG, Yew KC, Shelat VG. Does size matter for resection of giant versus non-giant hepatocellular carcinoma? A meta-analysis. World J Gastrointest Surg 2023; 15(2): 273-286 [PMID: 36896301 DOI: 10.4240/wjgs.v15.i2.273]
Corresponding Author of This Article
Aaron JL Lee, MBBS, Doctor, Lee Kong Chian School of Medicine, Nanyang Technological University, No. 11 Mandalay Rd, Singapore 308232, Singapore. alee047@e.ntu.edu.sg
Research Domain of This Article
Surgery
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
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/
World J Gastrointest Surg. Feb 27, 2023; 15(2): 273-286 Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.273
Does size matter for resection of giant versus non-giant hepatocellular carcinoma? A meta-analysis
Aaron JL Lee, Andrew GR Wu, Kuo Chao Yew, Vishal G Shelat
Aaron JL Lee, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
Andrew GR Wu, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Kuo Chao Yew, Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore 308433, Singapore
Vishal G Shelat, Department of Hepato-Pancreatico-Biliary Surgery, Tan Tok Seng Hospital, Singapore 308433, Singapore
Author contributions: Lee AJ, Wu AG, Yew KC, Shelat VG confirm contribution to study conception and design; Lee AJ, Wu AG contributed to data collection; Lee AJ, Wu AG contributed to analysis and interpretation of results; Lee AJ, Wu AG, Yew KC, Shelat VG contributed to draft manuscript preparation; All authors reviewed the results and approved the final version of the manuscript
Conflict-of-interest statement: The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interests in the subject matter or materials discussed in this manuscript.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Aaron JL Lee, MBBS, Doctor, Lee Kong Chian School of Medicine, Nanyang Technological University, No. 11 Mandalay Rd, Singapore 308232, Singapore. alee047@e.ntu.edu.sg
Received: October 11, 2022 Peer-review started: October 11, 2022 First decision: November 6, 2022 Revised: November 19, 2022 Accepted: February 1, 2023 Article in press: February 1, 2023 Published online: February 27, 2023
ARTICLE HIGHLIGHTS
Research background
There is currently no consensus on the inclusion of tumor size in hepatocellular carcinoma (HCC) staging systems. Furthermore, the size cut-off may vary in systems that incorporate tumor size, and a consensus is warranted for inclusion of size into the staging criteria with cut-off to be determined by multi-center collaborative clinical studies.
Research motivation
Research on long-term survival after resection of giant (≥ 10 cm) and non-giant HCC (< 10 cm) has produced conflicting results.
Research objectives
This study aimed to investigate whether oncological outcomes and safety profiles of resection differ between giant and non-giant HCC.
Research methods
PubMed, MEDLINE, EMBASE, and Cochrane databases were searched. Studies designed to investigate the outcomes of giant vs non-giant HCC were included. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoints were postoperative complications and mortality rates. All studies were assessed for bias using the Newcastle–Ottawa Scale.
Research results
24 retrospective cohort studies involving 23747 patients (giant = 3326; non-giant = 20421) who underwent HCC resection were included. OS was reported in 24 studies, DFS in 17 studies, 30-d mortality rate in 18 studies, postoperative complications in 15 studies, and post-hepatectomy liver failure (PHLF) in six studies. The HR was significantly lower for non-giant HCC in both OS (HR 0.53, 95%CI: 0.50-0.55, P < 0.001) and DFS (HR 0.62, 95%CI: 0.58-0.84, P < 0.001). No significant difference was found for 30-d mortality rate (OR 0.73, 95%CI: 0.50-1.08, P = 0.116), postoperative complications (OR 0.81, 95%CI: 0.62-1.06, P = 0.140), and PHLF (OR 0.81, 95%CI: 0.62-1.06, P = 0.140).
Research conclusions
Resection of giant HCC is associated with poorer long-term outcomes. The safety profile of resection was similar in both groups; however, this may have been confounded by reporting bias. HCC staging systems should account for the size differences.
Research perspectives
Future prospective studies should investigate different modalities of intervention for giant HCC to determine whether these treatments can provide better quality of life outcomes with low therapy-associated morbidity.
