Postoperative mortality after liver resection for hepatocellular carcinoma—A systematic review. Metanalysis and metaregression of studies published in the last 5 years

Abstract

Aim This systematic review and meta‐analysis aimed to analyse 90 days of mortality after liver resection for hepatocellular carcinoma. Methods PubMed, Cochrane Library, Embase, Google Scholar, Web of Science were searched with keywords mesh terms like ‘Hepatocellular carcinoma’; ‘liver resection”;” mortality”;” hepatectomy”, “postoperative mortality”, “Hepatocellular carcinoma AND mortality”, “liver resection AND mortality”, “hepatectomy AND mortality.” Weighted percentage 90 days mortalities were analysed. Random effect meta‐analysis was done by DerSimonian‐Laird methods. Heterogeneity was assessed using the Higgins I2 test. Publication bias was assessed using a funnel plot. Funnel plot asymmetry was evaluated by Egger's test. Results A total of 8474 patients underwent liver resection. 301 patients died within 90 days postoperatively. Weighted 90 days mortality was 4.2% (95% CI 3.0–5.4%). Heterogeneity was significant (I2 = 89.96%, p < .001). We analysed various covariates like major hepatectomy, age, open surgery, more than one tumour nodule, the median size of the largest tumour and cirrhotic liver to check for their association with heterogeneity in the analysis and hence 90 days mortality. On metaregression analysis open hepatectomy (p = .044) was associated with heterogeneity in the analysis and 90 days mortality. Conclusion 90 days mortality after liver resection is 3–5.4%. Differences across the studies may be due to various associated factors.