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A Comprehensive Meta-regression Analysis on Outcome of Anatomic Resection Versus Nonanatomic Resection for Hepatocellular Carcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

It remains unclear whether hepatectomy for hepatocellular carcinoma should be performed as an anatomic resection (AR) or a nonanatomic resection (NAR). Because no randomized controlled trials are currently available on this topic, a meta-regression analysis was performed on available observational studies to control for confounding variables.

Methods

A systematic review of studies published from 1990 to 2011 in the PubMed and Embase databases was performed. Patient and disease-free survival (DFS), postoperative mortality, and morbidity were considered as outcomes. Results are expressed as relative risk (RR) or weighted mean differences with 95 % of confidence interval.

Results

Eighteen observational studies involving 9,036 patients were analyzed: 4,012 were in the AR group and 5,024 in the NAR group. Meta-analysis suggested that AR provided better 5-year patient survival (RR 1.14; P = 0.001) and DFS than NAR (RR 1.38; P = 0.001). However, patients in the NAR group were characterized by a higher prevalence of cirrhosis (RR 1.27; P = 0.010), more advanced hepatic dysfunction (RR 0.90 for Child-Pugh class A; P = 0.001) and smaller tumor size (weighted mean difference 0.36 cm; P < 0.001) compared with patients in the AR group. Meta-regression analysis showed that the different proportion of cirrhosis in the NAR group significantly affected both 5-year patient survival (RR 1.28; P = 0.016) and DFS (RR 1.74; P = 0.022). Tumor size only slightly affected DFS (RR 1.72; P = 0.076). Postoperative mortality and morbidity were unaffected (P > 0.05 in all cases).

Conclusions

Patient survival and DFS after AR seem to be superior to NAR because the worse liver function reserve in the NAR group significantly affects prognosis.

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Acknowledgment

We thank A. Muratore of the Department of Hepato-Biliary-Pancreatic and Digestive Surgery, Ospedale Mauriziano Umberto I, Torino, Italy, and A. Kobayashi of the First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan, for providing additional data.

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Authors and Affiliations

  1. Liver and Multiorgan Transplant Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Alessandro Cucchetti MD, Matteo Cescon MD, Giorgio Ercolani MD, Eleonora Bigonzi MD & Antonio D. Pinna MD

  2. Liver Surgery Unit, Third Department of Surgery, Humanitas Cancer Center, IRCCS Istituto Clinico Humanitas, University of Milan School of Medicine, Rozzano, Milan, Italy

    Guido Torzilli MD

Authors
  1. Alessandro Cucchetti MD
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  2. Matteo Cescon MD
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  3. Giorgio Ercolani MD
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  4. Eleonora Bigonzi MD
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  5. Guido Torzilli MD
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  6. Antonio D. Pinna MD
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Correspondence to Alessandro Cucchetti MD.

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Cucchetti, A., Cescon, M., Ercolani, G. et al. A Comprehensive Meta-regression Analysis on Outcome of Anatomic Resection Versus Nonanatomic Resection for Hepatocellular Carcinoma. Ann Surg Oncol 19, 3697–3705 (2012). https://doi.org/10.1245/s10434-012-2450-z

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  • DOI: https://doi.org/10.1245/s10434-012-2450-z

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