Efficacy Of Precise Hepatectomy For Treatment Of Primary Liver Cancer:a Meta-analysis

Objective: To assess the efficacy of precise hepatectomy in the treatment of primary liver cancer and provide the basis for clinical treatment of surgical options. Methods: PubMed, Chinese Biomedical Database(CBM), CNKI and Wanfang databases were searched to identify randomized controlled trials and non-randomized controlled trials that assessed the efficacy of precise hepatectomy and traditional irregular hepatectomy in treatment of primary liver cancer from January 2008 to March 2013.The eligible trials were extracted according to the inclusion and exclusion criteria. The included trials were evaluated the methodological quality and strength of evidence. RevMan 5.1 software was used for statistical analysis of intraoperative, postoperative and prognostic measures. Results:A total of five studies involving 580 patients were included. Meta-analysis showed that compared with the traditional irregular hepatectomy group,length of hospital stay [MD=-2.63,95%CI(-3.59,-1.67), P<0.00001], rate of positive margins [OR=0.12, 95%CI(0.04,0.41),P=0.0007],postoperative ALT [MD=-185.32,95%CI(-355.58,-15.06), P=0.03] and AST [MD=-156.09,95%CI(-230.62,-81.56), P<0.0001], complications [OR=0.37,95%CI(0.23,0.58), P<0.0001],1-year recurrence rate [OR=0.43,95%CI (0.28, 0.66), P=0.0001] and 1-year survival rate of year [OR=1.92,95%CI (1.19,3.11), P=0.008] were better in the precise hepatectomy group.However, there were no significant differences between the two groups in the operative time [MD=28.80,95%CI(-99.37, 156.98), P=0.66], intraoperative blood loss [MD=-155.36,95%CI(-312.32,1.59),P=0.05], average rate of perioperative blood transfusion [OR=0.73,95%CI(0.44,1.21),P=0.23], and postoperative albumin [MD=1.99,95%CI(-1.93,5.91), P=032] and total bilirubin [MD=-5.48,95%CI(-10.93,-0.03), P=0.05]. Conclusion:Analysis evidence showed that the precise hepatectomy group is superior to the traditional irregular hepatectomy group in the aspect of length of hospital stay, rate of positive margins, postoperative ALT and AST, complications,1-year recurrence rate and 1-year survival rate of year, no evidence showed that which procedure has superiority in other aspects.Precise hepatectomy is more safe and effective than traditional irregular hepatectomy in the treatment of primary liver cancer. Due to the poor quality and small sample size of included trials, more well-designed randomized controlled trails should be performed.