A systematic review and meta-analysis on the treatment of liver hydatid cyst using meta-MUMS tool: comparing PAIR and laparoscopic procedures

Abstract

Introduction: There is an academic debate over surgical treatments of liver hydatid cyst disease. In this study, a systematic review and meta-analysis were carried out in order to evaluate the pros and cons of both PAIR (Puncture, Aspiration, Injection, Respiration) and laparoscopic techniques by considering the outcomes of liver hydatid cysts.

Material and methods: We designed descriptive Boolean queries to search two databases, PubMed and Scopus, to derive the articles published in the period of January 2000 to December 2016 in order to evaluate the outcomes of these research articles. The outcomes of laparoscopic and PAIR procedures include the rates of cure, postoperative complications, recurrences, and mortality, which were extracted, assessed, and used as their corresponding effect sizes.

Results: Fifty-seven studies including a total of 2832 patients (PAIR group n = 1650 and laparoscopic group = 1182) were analyzed. In this meta-analysis study, a random effect model of correlations of outcomes (postoperative complications, mortalities, recurrences, and cure rates) of PAIR and laparoscopy procedures was used. The meta-analysis and the forest plots of the two procedures show that the PAIR approach is superior in terms of cure, complication, and mortality rates compared with the laparoscopy technique. However, the recurrence rate is low in laparoscopic approaches. Moreover, Egger's tests for determining publication bias and heterogeneity tests were also performed.

Conclusions: This study shows promising trends toward an advantage of PAIR procedures in treatment of liver hydatid cyst in comparison with laparoscopic procedures. The PAIR procedure is superior to laparoscopy due to having a higher cure rate and lower complication and mortality rates; however, the latter has a lower recurrence rate.

Keywords: PAIR; echinococcosis; hydatid cyst; laparoscopy; liver; meta-analysis.

Figure 1

PRISMA flowchart for selecting relevant articles and patients

Figure 2

Forest plots of two procedures (A, C, E, G – forest plots of cure rates, postoperative complications, mortalities, and recurrences of PAIR group; B, D, F, H – forest plots of cure rates, postoperative complications, mortalities,and recurrences of Lap procedure)

Figure 2

Forest plots of two procedures (A, C, E, G – forest plots of cure rates, postoperative complications, mortalities, and recurrences of PAIR group; B, D, F, H – forest plots of cure rates, postoperative complications, mortalities,and recurrences of Lap procedure)

Figure 2

Forest plots of two procedures (A, C, E, G – forest plots of cure rates, postoperative complications, mortalities, and recurrences of PAIR group; B, D, F, H – forest plots of cure rates, postoperative complications, mortalities,and recurrences of Lap procedure)

Figure 2

Forest plots of two procedures (A, C, E, G – forest plots of cure rates, postoperative complications, mortalities, and recurrences of PAIR group; B, D, F, H – forest plots of cure rates, postoperative complications, mortalities,and recurrences of Lap procedure)

Figure 3

Meta-regression of two procedures: relation between (log cure, complications, and recurrences) and published year (A, C, E) for PAIR procedures (B, D), and Lap procedures

Figure 4

Meta-regression of two procedures: relation between (log cure, complications, and recurrences) and sample sizes (A, C, E) for PAIR procedures (B, D), and Lap procedures

Figure 5

Funnel plots of two procedures (A, C, E, G – funnel plots of cure rates, postoperative complications, mortalities, and recurrences of PAIR group; B, D, F, H – funnel plots of cure rates, postoperative complications, mortalities, and recurrences of Lap procedure)