Meta-Analysis
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World J Gastroenterol. Dec 7, 2014; 20(45): 17235-17243
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.17235
Anterior vs conventional approach hepatectomy for large liver cancer: A meta-analysis
Lei Li, Hai-Qing Wang, Qing Wang, Jian Yang, Jia-Yin Yang
Lei Li, Hai-Qing Wang, Qing Wang, Jian Yang, Jia-Yin Yang, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Sichuan Province, Chengdu 610041, China
Author contributions: Li L, Wang HQ, Yang J and Yang JY designed and performed the research and contributed new reagents and analytic tools; Li L, Wang HQ and Wang Q analyzed the data; Li L and Wang HQ wrote the paper.
Supported by Grants from the National Science and Technology Major Project of China, No. 2012ZX10002-016 and No. 2012ZX10002-017
Correspondence to: Jia-Yin Yang, MD, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Sichuan Province, Chengdu 610041, China. yangjygyz@163.com
Telephone: +86-28-85422867 Fax: +86-28-85422867
Received: May 4, 2014
Revised: July 1, 2014
Accepted: July 24, 2014
Published online: December 7, 2014
Processing time: 220 Days and 3.7 Hours
Abstract

AIM: To evaluate the clinical outcomes and safety of anterior- and conventional-approach hepatectomy for patients with large liver tumors.

METHODS: PubMed, EMBASE, Google Scholar and the Cochrane Library databases were searched for randomized controlled trials (RCTs) and controlled clinical trials comparing anterior-approach hepatectomy (AAH) and conventional-approach hepatectomy (CAH). Two observers independently extracted the data using a spreadsheet and assessed the studies for inclusion. Studies that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed using either fixed effects or random effects models.

RESULTS: Two RCTs and six controlled clinical trials involving 807 patients met the predefined inclusion criteria. A total of 363 patients underwent AAH and 444 underwent CAH. Meta-analysis indicated that the AAH group had fewer requirements for transfusion (OR = 0.37, 95%CI: 0.21-0.63), less recurrence (OR = 0.57, 95%CI: 0.37-0.87), and lower mortality (OR = 0.29, 95%CI: 0.13-0.63). There were no significant differences between AAH and CAH with regard to perioperative complications (OR = 0.94, 95%CI: 0.58-1.51), intraoperative tumor rupture (OR = 0.98, 95%CI: 0.40-2.40), or length of hospital stay (weighted mean difference = -0.17, 95%CI: -2.36-2.02).

CONCLUSION: AAH has advantages of decreased transfusion, mortality and recurrence compared to CAH. It is a safe and effective method for large cancers requiring right hepatectomy.

Keywords: Anterior approach; Conventional approach; Hepatectomy; Liver tumor; Meta-analysis

Core tip: Hepatectomy remains one of the best treatments of choice for primary or metastatic liver tumors of the right hepatic lobe. Anterior and conventional approaches are the most common methods for liver resection. We conducted a systematic review and meta-analysis to evaluate their feasibility, safety and efficacy. Anterior approach hepatectomy has more advantages than the conventional approach, and no significant difference from the conventional approach for perioperative complications, intraoperative tumor rupture, and length of hospital stay.