The Efficacy And Safety Of Liver Hanging Maneuver Hepatectomy For Liver Cancer:a Meta-analysis

Objective:To analyse the efficacy and safety of liver hanging maneuver(LHM)in the treatment of liver cancer.Methods:A thorough search of Pubmed,Embase,the Cochrane library the Chinese BioMedical Literature(CBM),and the China National Knowledge Infrastructure(CNKI)databases was performed to identify relevant articles up to December 2016.Comparative studies,including randomized controlled trials(RCTs)and non-randomized controlled trials(NRCTs),reporting the outcomes of both liver hanging maneuver(LHM)and Conventional Approach(CA)for liver cancer were included in this meta-analysis.Additional studies were identified by a manual search of all the references of all retrieved articles.All eligible literatures were included according to the inclusion and exclusion criteria.Quality assessment was made based on the Cochrane Collaboration's risk of bias tool or Newcastle-Ottawa Scale,which was recommended in Cochrane Handbook for Systematic Reviews of Interventions.Data were analyzed using RevMan,version 5.3.Results:Five eligible studies were finally included,including 330 patients.The results of Meta-analyis show that,compared with CA hepatectomy,LHM hepatectomy could reduce intraoperative blood loss(MD=-152.06,95%CI-259.51—-44.62,p=0.006)and postoperative complications morbidity(OR=0.60,95%CI 0.37—0.97,p=0.04),meanwhile,the patients undergoing LHM hepatectomy had lower recurrence rate(OR=0.34,95%CI 0.18—0.63,p=0.0007)and higher 3-year OS rate(OR=2.53,95%CI 1.10—5.81,p=0.03).there was no statistical difference in operative time,blood transfusion rate,hospital mortality,length of hospital stay and 1-year OS rate.(all P>0.05)Conclusions:Based on current evidence,Compared to conventional approach hepatectomy,LHM hepatectomy could improves surgical outcomes,including reducing the intraoperative blood loss and postoperative complication morbility,.With regard to long-term and oncologic outcomes,LHM hepatectomy could decrease the recurrence rate of liver cancer,and achieve better 3-year overall survivals(OS)for patients.However,further large-sized,well-designed and multicentric randomized controlled trials are still required before strong recommendations can be made.