Anterior vs conventional approach hepatectomy for large liver cancer:A meta-analysis

作     者：Lei Li Hai-Qing Wang Qing Wang Jian Yang Jia-Yin Yang 

作者机构：Department of Liver Surgery Liver Transplantation Center West China Hospital of Sichuan University 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2014年第20卷第45期

页      面：17235-17243页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：Supported by Grants from the National Science and Technol-ogy Major Project of China No.2012ZX10002-016 and No.2012ZX10002-017 

主　　题：Anterior approach Conventional approach Hepatectomy Liver tumor Meta-analysis 

摘      要：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. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.