Anterior vs conventional approach hepatectomy for large liver cancer: a meta-analysis.
AIM
To evaluate the clinical outcomes and safety of anterior- and conventional-approach hepatectomy for patients with large liver tumors.


METHODS
PubMed, EMBASE, Google Scholar and the Cochrane Library databases were searched for randomized controlled trials (RCTs) and controlled clinical trials comparing anterior-approach hepatectomy (AAH) and conventional-approach hepatectomy (CAH). Two observers independently extracted the data using a spreadsheet and assessed the studies for inclusion. Studies that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed using either fixed effects or random effects models.


RESULTS
Two RCTs and six controlled clinical trials involving 807 patients met the predefined inclusion criteria. A total of 363 patients underwent AAH and 444 underwent CAH. Meta-analysis indicated that the AAH group had fewer requirements for transfusion (OR = 0.37, 95%CI: 0.21-0.63), less recurrence (OR = 0.57, 95%CI: 0.37-0.87), and lower mortality (OR = 0.29, 95%CI: 0.13-0.63). There were no significant differences between AAH and CAH with regard to perioperative complications (OR = 0.94, 95%CI: 0.58-1.51), intraoperative tumor rupture (OR = 0.98, 95%CI: 0.40-2.40), or length of hospital stay (weighted mean difference = -0.17, 95%CI: -2.36-2.02).


CONCLUSION
AAH has advantages of decreased transfusion, mortality and recurrence compared to CAH. It is a safe and effective method for large cancers requiring right hepatectomy.
['Li|Lei|L|', 'Wang|Hai-Qing|HQ|', 'Wang|Qing|Q|', 'Yang|Jian|J|', 'Yang|Jia-Yin|JY|']
D016063:Blood Loss, Surgical D001803:Blood Transfusion D016009:Chi-Square Distribution D006498:Hepatectomy D006801:Humans D007902:Length of Stay D008113:Liver Neoplasms D009364:Neoplasm Recurrence, Local D016017:Odds Ratio D011183:Postoperative Complications D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome D047368:Tumor Burden
Conventional approach Hepatectomy Meta-analysis Liver tumor Anterior approach