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Review
. 2014 Dec 7;20(45):17235-43.
doi: 10.3748/wjg.v20.i45.17235.

Anterior vs conventional approach hepatectomy for large liver cancer: a meta-analysis

Lei Li  1 , Hai-Qing Wang  1 , Qing Wang  1 , Jian Yang  1 , Jia-Yin Yang  1
Affiliations
Review

Anterior vs conventional approach hepatectomy for large liver cancer: a meta-analysis

Lei Li et al. World J Gastroenterol. .

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.

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Figures

Figure 1
Figure 1
Meta-analysis of transfusion requirement. AAH: Anterior approach hepatectomy; CAH: Conventional approach hepatectomy.
Figure 2
Figure 2
Meta-analysis of complications. AAH: Anterior approach hepatectomy; CAH: Conventional approach hepatectomy.
Figure 3
Figure 3
Meta-analysis of mortality. AAH: Anterior approach hepatectomy; CAH: Conventional approach hepatectomy.
Figure 4
Figure 4
Meta-analysis of tumor recurrence. AAH: Anterior approach hepatectomy; CAH: Conventional approach hepatectomy.
Figure 5
Figure 5
Funnel plots. A: Seven articles in the meta-analysis of transfusion requirement; B: Eight articles in the meta-analysis of complications; C: Seven articles in the meta-analysis of mortality; D: Three articles in the meta-analysis of tumor recurrence.
See this image and copyright information in PMC

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