Does size matter for resection of giant versus non-giant hepatocellular carcinoma? A meta-analysis

doi:10.4240/wjgs.v15.i2.273

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World Journal of Gastrointestinal Surgery

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Meta-Analysis

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.

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
Processing time: 139 Days and 9.5 Hours

Abstract

BACKGROUND

Research on long-term survival after resection of giant (≥ 10 cm) and non-giant hepatocellular carcinoma (HCC) (< 10 cm) has produced conflicting results.

AIM

This study aimed to investigate whether oncological outcomes and safety profiles of resection differ between giant and non-giant HCC.

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.

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).

CONCLUSION

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.

Keywords: Hepatectomy; Giant hepatocellular carcinoma; Resection; Meta-analysis

Core Tip: Resection of giant hepatocellular carcinoma (HCC) is associated with poorer long-term outcomes, with a safety profile similar to that of resection of non-giant HCC. The importance of this is that HCC staging systems should account for the size differences.