Meta-analysis Of Clinical Effects Of Anterior Approach And Conventional Approach Hepatectomy For Large Hepatocellular Carcinoma

Objective:To systematically evaluate the safety and short-term and long-term clinical efficacy of anterior approach hepatectomy and conventional approach hepatectomy for large hepatocellular carcinoma.Methods:Chinese and English databases were retrieved by computer.The Chinese databases included China Knowledge Network,Wanfang,Weipu,and Chinese biomedical literature.English databases include PubMed,Medline,Embase,Web of Science,Ovid,Cochrane library,etc.The retrieval time range is from the establishment of each database to December 2019.Literature that met the inclusion criteria was screened,and use randomized controlled trials and non-randomized controlled trials to use bias risk assessment tools and the Newcastle-Ottawa scale to evaluate the quality of literature.Relevant data for research and comparison were extracted and meta-analysis was performed using statistical software Stata 12.0.Outcome indicators include surgery-related indicators(total intraoperative blood loss,intraoperative blood transfusion rate,total operation time),postoperative short-term efficacy index(incidence of postoperative complications,mean hospital stay,postoperative mortality),and long-term postoperative efficacy index(Tumor recurrence rate,overall survival rate at 1,3,and 5 years,and tumor-free survival rate at 1,3,and 5 years).P<0.05 was statistically significant.Results:Twenty studies(including 4 RCTs and 16 NRCTs)were finally included,with a total of 2683 patients,including 1295 patients in the anterior group and 1388 patients in the Conventional group.Meta analysis results show that compared with Conventional approach hepatectomy,anterior approach hepatectomy can effectively reduce intraoperative blood loss(MD=-149.261,95%CI:-200.632—97.890,P=0.000),and reduce Intraoperative blood transfusion rate(RR=0.617,95%C:0.534—0.713,P=0.000),reducing the incidence of postoperative complications(RR=0.827,95%CI:0.684—0.999,P=0.049)and postoperative mortality Rate(RR=0.527,95%CI:0.358—0.774,P=0.001),reducing the average length of hospital stay(MD=-3.023,95%Cl:-4.585--1.461,P=0.000).At the same time,the tumor recurrence rate was reduced(RR=0.817,95%CI:0.743—0.899,P=0.000),and the overall survival rate was improved for one year(RR=1.106,95%CI:1.015—1.206],P=0.022),3-year overall survival rate(RR=1.348,95%CI:1.087—1.672,P=0.006)and 5-year overall survival rate(RR=1.338,95%CI:1.165—1.538,P=0.000);also increased by the 1-year tumor-free survival rate(RR=1.360,95%CI:1.199—1.543,P=0.000),3-year tumor-free survival rate(RR=1.560,95%CI:1.137—2.140,P=0.000)and 5-year tumor-free survival rate(RR=1.316,95%CI:0.975-1.776,P=0.073).The total operation time(MD=4.392,95%CI:-14.918-23.701,P=0.656)was not statistically significant.Conclusions:For the treatment of hepatectomy for large hepatocellular carcinoma,compared with conventional approach hepatectomy,anterior approach hepatectomy can significantly reduce the total intraoperative blood loss and effectively reduce the intraoperative blood transfusion rate.From the perspective of short-term postoperative efficacy,anterior approach hepatectomy can significantly reduce the incidence of postoperative complications and mortality,and significantly shorten the length of hospital stay.From the perspective of long-term efficacy,anterior approach hepatectomy can effectively reduce the postoperative tumor recurrence rate of patients with large liver cancer,and the overall survival rate and tumor-free survival rate of 1 year,3 years,and 5 years are improved.However,there was no significant difference in total surgical time between the two groups.