Background: The benefit of anatomic (AR) versus parenchyma-sparing resection (PSR) in hepatocarcinoma (HCC) is still debated. The aim of the study was to compare AR vs. PSR in terms of overall survival (OS) and disease-free survival (DFS). Methods: A systematic review was conducted using Medline and Google Scholar. To reduce intra- and inter-study heterogeneity, only propensity-matched studies and randomized clinical trials (RCT) were evaluated and a generic inverse variance meta-analysis was run. A sub-analysis was performed in case of tumor microvascular invasion (MVI). Results: Eleven propensity-matched and one RCT were evaluated, with a total of 3445 patients (AR = 1776 and PSR = 1669). Tumor burden and liver function were comparable among studies (I2 < 50%, p > 0.5). OS was similar between AR and PSR (HR 0.93; 95%CI, 0.75–1.15; p = 0.50, I2 = 41%). DFS was improved in AR at 1 year (RR 0.84; 95%CI, 0.72–0.97; p = 0.02; I2 = 36%) and 3 years (RR 0.90; 95%CI, 0.83–0.98; p = 0.02; I2 = 40%) but not at 5 years (RR 0.94; 95%CI, 0.87–1.01; p = 0.07; I2 = 41%). Furthermore, in the presence of MVI, no difference in OS and DFS was observed between AR and PSR. Conclusion: When liver function and tumor burden are comparable, AR and PSR achieved similar overall survival. AR improved local control in the early period after surgery. Furthermore, in the presence of MVI, the extension of surgery was not associated with better OS and DFS.

Famularo, S., Ceresoli, M., Giani, A., Ciulli, C., Pinotti, E., Romano, F., et al. (2021). Is It Just a Matter of Surgical Extension to Achieve the Cure of Hepatocarcinoma? A Meta-Analysis of Propensity-Matched and Randomized Studies for Anatomic Versus Parenchyma-Sparing Liver Resection. JOURNAL OF GASTROINTESTINAL SURGERY, 25(1), 94-103 [10.1007/s11605-019-04494-5].

Is It Just a Matter of Surgical Extension to Achieve the Cure of Hepatocarcinoma? A Meta-Analysis of Propensity-Matched and Randomized Studies for Anatomic Versus Parenchyma-Sparing Liver Resection

Famularo S.;Ceresoli M.;Giani A.;Ciulli C.;Pinotti E.;Romano F.;Braga M.;De Carlis L.;Gianotti L.
2021

Abstract

Background: The benefit of anatomic (AR) versus parenchyma-sparing resection (PSR) in hepatocarcinoma (HCC) is still debated. The aim of the study was to compare AR vs. PSR in terms of overall survival (OS) and disease-free survival (DFS). Methods: A systematic review was conducted using Medline and Google Scholar. To reduce intra- and inter-study heterogeneity, only propensity-matched studies and randomized clinical trials (RCT) were evaluated and a generic inverse variance meta-analysis was run. A sub-analysis was performed in case of tumor microvascular invasion (MVI). Results: Eleven propensity-matched and one RCT were evaluated, with a total of 3445 patients (AR = 1776 and PSR = 1669). Tumor burden and liver function were comparable among studies (I2 < 50%, p > 0.5). OS was similar between AR and PSR (HR 0.93; 95%CI, 0.75–1.15; p = 0.50, I2 = 41%). DFS was improved in AR at 1 year (RR 0.84; 95%CI, 0.72–0.97; p = 0.02; I2 = 36%) and 3 years (RR 0.90; 95%CI, 0.83–0.98; p = 0.02; I2 = 40%) but not at 5 years (RR 0.94; 95%CI, 0.87–1.01; p = 0.07; I2 = 41%). Furthermore, in the presence of MVI, no difference in OS and DFS was observed between AR and PSR. Conclusion: When liver function and tumor burden are comparable, AR and PSR achieved similar overall survival. AR improved local control in the early period after surgery. Furthermore, in the presence of MVI, the extension of surgery was not associated with better OS and DFS.
Articolo in rivista - Articolo scientifico
Anatomic resection; HCC; Hepatocarcinoma; Meta-analysis; Non-anatomic resection; Parenchyma sparing resection; Survival;
English
2-gen-2020
2021
25
1
94
103
none
Famularo, S., Ceresoli, M., Giani, A., Ciulli, C., Pinotti, E., Romano, F., et al. (2021). Is It Just a Matter of Surgical Extension to Achieve the Cure of Hepatocarcinoma? A Meta-Analysis of Propensity-Matched and Randomized Studies for Anatomic Versus Parenchyma-Sparing Liver Resection. JOURNAL OF GASTROINTESTINAL SURGERY, 25(1), 94-103 [10.1007/s11605-019-04494-5].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/275523
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