Clinical effect of mesohepatectomy versus hemihepatectomy in treatment of centrally located hepatocellular carcinoma: A Meta-analysis

Objective To systematically review the clinical effect of mesohepatectomy versus hemihepatectomy in the treatment of centrally located hepatocellular carcinoma ( HCC) . Methods PubMed, EMBASE, Cochrane Library, CKNI, Wanfang Data, and VIP were searched for comparative studies on mesohepatectomy versus hemihepatectomy in the treatment of centrally located HCC. Related data were extracted, including time of operation, intraoperative blood loss, number of patients with postoperative liver failure, mortality rate in the perioperative period, overall survival rate, and disease-free survival rate, and Review Manager 5. 3 software was used for data analysis.The chi-square test was used to evaluate the heterogeneity between these studies. Odds ratio ( OR) was used for the analysis of binary variables, weighted mean difference ( WMD) was used for the analysis of continuous variables, and 95% confidence interval ( CI) was calculated for these variables. Results A total of 10 retrospective case-control studies which met the inclusion criteria were included, with a total sample size of 1861 patients ( 1054 in the mesohepatectomy group and 807 in the hemihepatectomy group) . The meta-analysis revealed that the mesohepatectomy group had a significantly lower incidence rate of postoperative liver failure than the hemihepatectomy group ( OR =0. 37, 95% CI: 0. 16-0. 87, P = 0. 02) , while there were no significant differences between the two groups in time of operation ( WMD =15. 17, 95% CI:-18. 75 to 49. 05, P = 0. 38) , intraoperative blood loss ( WMD = 100. 96, 95% CI:-15. 29 to 217. 21, P = 0. 09) , mortality rate in the perioperative period ( OR = 0. 55, 95% CI: 0. 26-1. 17, P = 0. 12) , incidence rate of bile leakage after surgery ( OR = 1. 32, 95% CI: 0. 74-2. 38, P = 0. 35) , overall survival rate, and disease-free survival rate. Conclusion Mesohepatectomy can significantly reduce the risk of postoperative liver failure. For patients with centrally located HCC and liver cirrhosis, experienced surgeons may give priority to mesohepatectomy.