Negative surgical margin improved long-term survival of XXXX after hepatic resection: a systematic review and meta-analysis.

@entity5 @entity1 @entity4960 @entity14
OBJECTIVE: The need to achieve a @entity5 -free margin of >= 1 mm (R0) for @entity14 ( @entity14 ) after hepatic resection has been questioned recently. This study conducted a meta-analysis to determine whether status of the surgical margin still influenced the long-term outcome of survival and recurrence rate. METHODS: Eligible trials that compared survival and recurrence rates of R0 versus the @entity5 -free margin <1 mm (R1) were identified from Embase, PubMed, the Web of Science, and the Cochrane Library since their inception to 1 March 2015. The study outcomes included long-term outcome of survival and recurrence rate. Hazard ratio (HR) with a 95 % confidence interval was used to measure the pooled effect according to a random-effects model or fixed-effects model, depending on the heterogeneity among the included studies. The heterogeneity among these trials was statistically evaluated using the   (2) and I(2) tests. Sensitivity analyses and publication bias were also carried out. RESULTS: A total of 18 studies containing 6790 @entity1 were included. The comparison between @entity4960 revealed that a pooled HR for 5-year overall survival was 1.603 (95 % CI; 1.464-1.755; p   =   0.000; I(2)   =   31.2 %, p   =   0.141). For @entity1 received modern chemotherapy; a pooled HR of R1 resection for 5-year overall survival was 1.924 (95 % CI; 1.567-2.361, p   =   0.000; I(2)   =   20.5 %, p   =   0.273). The pooled HR for 5-year OS of >= 1 cm in the included studies calculated using the random-effects model was 0.819 (95 % CI; 0.715-0.938, p   =   0.004; I(2)   =   0 %, p   =   0.492). CONCLUSIONS: R1 resections decreased long-term survival, and modern chemotherapy did not alter an adverse outcome. Surgeons should attempt to obtain a 1-cm margin.
