Central hepatectomy versus major hepatectomy for patients with centrally located hepatocellular carcinoma; a systematic review and meta-analysis

Abstract

Background and Aim: For those with a centrally located HCC, the two types of liver sectionectomy that can be performed are extended hepatectomy (EH) and central hepatectomy (CH). The aim of this meta-analysis was to compare the short- and long-term outcomes between patients treated with CH and patients treated with EH for those with centrally located HCC. Method: We searched PubMed, Scopus, Web of Science, Cochrane library for eligible studies from inception to 1 April 2022 and a systematic review and meta-analysis were done to compare the outcomes between the two groups. Results: we included 9 studies with total of 1674 patients in this study. The pooled results in this meta-analysis showed equal long-term overall survival, Disease free survival, recurrence and mortality between the two groups (5-year OS, RR = 1.14, 95% CI = 0.96-1.35, P = 0.12; I2 = 56%), (5-year DFS, RR = 0.81, 95% CI = 0.61-1.08, P = 0.15; I2 = 60%), (Recurrence, RR =1.04, 95% CI = 0.94-1.15, P = 0.45; I2 = 27%), and (Mortality, RR =0.55, 95% CI = 0.26-1.15, P = 0.11; I2 = 0 %). In addition to that, no significant difference could be detected in the overall incidence of complications between the two groups (Complications, RR =0.94, 95% CI = 0.76-1.16, P = 0.57; I2 = 0 %).However, CH is associated with a remarkable increase in the rate of biliary fistula (Biliary fistula, RR =1.90, 95% CI = 1.07-3.40, P = 0.03; I2 = 0%). And Liver cell failure was higher in case of EH (LCF, RR =0.47, 95% CI = 0.30-0.76, P = 0.002; I2 = 0%). Regarding the operative details, CH is associated with longer operative time (Time of the operation, Mean difference = 0.82, 95% CI = 0.36, 1.27, P = 0.0004; I2 = 57%). Conclusion: No significant difference in the short and long-term survival and recurrence between CH and MH for CL-HCC. However, CH is associated with greater future remnant liver volume that decreases the incidence of LCF and provides more opportunities for a repeat hepatectomy after tumor recurrence.