Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Oct 26, 2016; 4(5): 105-117
Published online Oct 26, 2016. doi: 10.13105/wjma.v4.i5.105
Isolated hepatic perfusion for unresectable hepatic malignancies: A systematic review and meta-analysis
Tian Meng, Guan-Qiao Li, Meng-Hua Dai
Tian Meng, Meng-Hua Dai, Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
Guan-Qiao Li, Peking Union Medical College, Beijing 100730, China
Guan-Qiao Li, Medical School, Tsinghua University, Beijing 100085, China
Author contributions: Meng T and Dai MH designed the research; Meng T and Li GQ performed the research; Meng T analyzed the data; Meng T and Li GQ wrote the paper; Dai MH reviewed the manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
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: Tian Meng, MD, Department of General Surgery, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, China. 42556973@qq.com
Telephone: +86-10-81568211
Received: April 3, 2016
Peer-review started: April 7, 2016
First decision: June 12, 2016
Revised: June 24, 2016
Accepted: August 15, 2016
Article in press: August 16, 2016
Published online: October 26, 2016
Processing time: 201 Days and 1 Hours
Abstract
AIM

To investigate the efficacy and safety of isolated hepatic perfusion (IHP) in the management of unresectable liver malignancies.

METHODS

Studies were identified manually and on-line by using PubMed and EMBASE database. We formulate the eligibility criteria according to the PICOS elements, and accessed the quality of studies using the MINORS instrument. Data from all included studies were carefully investigated. We calculated the pooled response rate and incidences of mortality reported from all eligible studies by using the Meta-Analyst software, and we computed a pooled relative risk (RR) and 95%CI by using the Comprehensive Meta-Analysis software. Heterogeneity was quantified evaluated using I2 statistic.

RESULTS

Eight studies, including 502 patients, were selected. Of these, six studies performed IHP, while the other two studies performed percutaneous IHP. The results showed that the pooled response rate was 60.8% (95%CI: 53.1%-68%), I2 = 37.1%. The median overall survival was 20 mo (range: 12.1 to 25 mo) following IHP or PIHP. The pooled mortality rate was 5.4% (95%CI: 2.5%-11.2%), I2 = 37.5%. Prognostic factors predict the response to IHP or survival, and were reported in six studies. Meta-analysis demonstrated that Gender was not associated with overall survival (RR = 0.877, 95%CI: 0.564-1.365); however, carcino-embryonic antigen ≤ 30 ng/mL was associated with a significant improvement in survival outcomes with colorectal cancer patients (RR = 2.082, 95%CI: 1.371-3.163), and there was no significant heterogeneity.

CONCLUSION

The present systemic review and meta-analysis suggest that IHP and PIHP are potentially efficient and safe techniques for unresectable liver primary and secondary malignancies.

Keywords: Isolated hepatic perfusion; Unresectable; Hepatic malignancy; Systematic review; Meta-analysis

Core tip: The treatment of unresectable liver malignancies is an important and difficult clinical problem. Many studies suggested that isolated hepatic perfusion to be efficacious and safe in the management of unresectable liver malignancies. However, there has not yet been a systematic analysis to evaluate this method. Therefore we reviewed all the literature we could get and conducted a systemic review. In the present systemic review we demonstrated all details and results of this technique in every aspect and intensively investigated these data, so that it will help readers to understand this technique in a quick, comprehensive and objective way.