Meta-analysis Of Emergency Resection Versus Staged Liver Resection For Spontaneous Ruptured Hepatocellular Carcinoma

Objective: Comparison of the efficacy and safety of emergency liver resection and staged liver resection in the treatment for spontaneous ruptured hepatocellular carcinoma.Methods: Based on the PICOS principle,a literature search strategy and inclusion and exclusion criteria were developed.PubMed,Web of science,Embase,Cochrane Library,CNKI,Wanfang,Weipu and other medical literature batabase were systematically searched for eligible studies that compared emergency hepatectomy(EH)and staged hepatectomy(SH)for resectable spontaneous ruptured hepatocellular carcinoma.The reference lists of the included articles were also reviewed.Literature screening was performed according to the inclusion and exclusion criteria.The two researchers independently extracted the relevant data included in the literature and cross-checked.In case of disagreement between the two parties,they were resolved through discussion or third-party coordination.If the relevant data of the included study is missing,the correspondence author will be contacted to obtain the data.The analysis was performed using Revman 5.3 software.The continuous variables and dichotomous variables respectively used Mean difference(MD)and odds ratio(OR)as effect indicators.Their combined values and 95% CI were calculated.The choice of random effect model or fixed effect model is adopted according to the size of heterogeneity.Results: Fifteen studies were included,with a total of 712 patients,comprising of 354 EH cases and 358 SH cases.The results of meta-analysis showed: Compared with EH group,SH group had less intraoperative blood loss(MD=426.78,95%CI =340.57-513.00,P < 0.00001),less intraoperative blood transfusion(MD=796.69,95%CI=688.27-905.12,P<0.00001),lower perioperative complications(OR=2.17,95%CI=1.17-4.03,P=0.01)and lower perioperative mortality(OR=5.85,95%CI =2.32-14.74,P=0.0002).In addition,1-year survival rates(OR=0.58,95%CI=0.41-0.80,P=0.001)and 3-year survival rates(OR=0.63,95%CI =0.42-0.93,P=0.02)were significantly higher in the SH group.There was no significant difference between the two groups in operation time and peritoneal metastasis rate(MD=-4.02,95%CI =-12.14-4.09,P=0.33,peritoneal metastasis rate: OR=1.08,95%CI = 0.88-2.03,P=0.81).The mean hospital stay in the EH group was significantly lower than that in the SH group(MD=-4.32,95%CI =-6.11--2.54,P < 0.00001).Conclusion: The safety of SH is better than that of EH,with less bleeding,low perioperative complications and low mortality.2.DH is better than EH in the treatment of ruptured liver cancer bleeding.The 1-year and 3-year survival rate of patients with DH is higher.3.However,due to the limitation of the number and sample size of the included studies,the above conclusions still need to be verified by the multi-center randomized controlled clinical trials with larger sample size and higher quality.