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Meta-Analysis
. 2024 Sep 13;409(1):277.
doi: 10.1007/s00423-024-03466-x.

The role of resection in hepatocellular carcinoma BCLC stage B: A multi-institutional patient-level meta-analysis and systematic review

Victor Lopez-Lopez #  1 , Fabian Kalt #  2 , Jian-Hong Zhong  3 , Cristiano Guidetti  4 , Paolo Magistri  4 , Fabrizio Di Benedetto  4 , Arndt Weinmann  5 , Jens Mittler  6 , Hauke Lang  6 , Rohini Sharma  7 , Mathew Vithayathil  7 , Samir Tariq  7 , Patricia Sánchez-Velázquez  8 , Gianluca Rompianesi  9 , Roberto Ivan Troisi  9 , Concepción Gómez-Gavara  10 , Mar Dalmau  10 , Francisco Jose Sanchez-Romero  2 , Camilo Llamoza  2 , Christoph Tschuor  11 , Uluk Deniz  12   13 , Georg Lurje  12   13 , Peri Husen  13 , Sandro Hügli  1 , Jan Philipp Jonas  2 , Fabian Rössler  2 , Philipp Kron  2 , Michaela Ramser  2 , Pablo Ramirez  2 , Kuno Lehmann  2 , Ricardo Robles-Campos  1 , Dilmurodjon Eshmuminov  14
Affiliations
Meta-Analysis

The role of resection in hepatocellular carcinoma BCLC stage B: A multi-institutional patient-level meta-analysis and systematic review

Victor Lopez-Lopez et al. Langenbecks Arch Surg. .

Erratum in

Abstract

Purpose: The Barcelona Clinic Liver Cancer (BCLC) staging schema is widely used for hepatocellular carcinoma (HCC) treatment. In the updated recommendations, HCC BCLC stage B can become candidates for transplantation. In contrast, hepatectomy is currently not recommended.

Methods: This systematic review includes a multi-institutional meta-analysis of patient-level data. Survival, postoperative mortality, morbidity and patient selection criteria for liver resection and transplantation in BCLC stage B are explored. All clinical studies reporting HCC patients with BCLC stage B undergoing liver resection or transplantation were included.

Results: A total of 31 studies with 3163 patients were included. Patient level data was available for 580 patients from 9 studies (423 after resection and 157 after transplantation). The overall survival following resection was 50 months and recurrence-free survival was 15 months. Overall survival after transplantation was not reached and recurrence-free survival was 45 months. The major complication rate after resection was 0.11 (95%-CI, 0.0-0.17) with the 90-day mortality rate of 0.03 (95%-CI, 0.03-0.08). Child-Pugh A (93%), minor resection (60%), alpha protein level less than 400 (64%) were common in resected patients. Resected patients were mostly outside the Milan criteria (99%) with mean tumour number of 2.9. Studies reporting liver transplantation in BCLC stage B were scarce.

Conclusion: Liver resection can be performed safely in selected patients with HCC BCLC stage B, particularly if patients present with preserved liver function. No conclusion can done on liver transplantation due to scarcity of reported studies.

Keywords: BCLC-B; HCC; Liver resection; Liver transplantation.

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Conflict of interest statement

None.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study selection
Fig. 2
Fig. 2
(a) Overall survival resected patients, (b) Recurrence free survival resected patients, (c) Overall survival transplanted patients, (d) Recurrence free survival transplanted patients
Fig. 3
Fig. 3
(a) Overall complication rate, (b) Major complication rate, (c) 90 day mortality, (d) Minor resection rate
See this image and copyright information in PMC

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