Short-term efficacy of precise hepatectomy and traditional hepatectomy for primary liver cancer: a systematic review and meta-analysis

Abstract

Background: As the base of hepatitis B patients has been increasing annually, it has developed into a high incidence source of primary liver cancer worldwide. The fatality rate of liver cancer is still relatively high. Among the many treatment methods, liver resection is the first-line treatment of primary liver cancer.Although precision hepatectomy has achieved rapid development in recent years, the understanding of its efficacy is still not completely clear. This study aimed to analyze and compare the safety and effectiveness of precision hepatectomy and traditional hepatectomy in the treatment of primary liver cancer. Methods: We performed a literature search of the CNKI, Wanfang, Weipu.com, PubMed, Cochrane Library, Web of Science databases for studies on precision liver resection (precision group) and traditional liver resection (traditional group) for the treatment of primary liver cancer. Data including the operation time, intraoperative blood loss, hospital stay, postoperative complications, liver function, and survival rate were analyzed using RevMan 5.3 software to compare the differences in the effects of the two surgical procedures. Results: Ten articles were included in the study, involving a total of 1,969 patients, including 1,045 cases in the precision group and 924 cases in the traditional group. Meta-analysis results showed that compared with the traditional group, the precision group had a longer operation time [mean difference (MD) =8.01, P=0.004], and total bilirubin (TBiL; MD =-2.78, P=0.055) was similar. Meanwhile, the precision group exhibited advantages in terms of intraoperative blood loss (MD =-149.37, P=0.000), hospital stay (MD =-5.59, P=0.000), postoperative liver function indexes [aspartate aminotransferase (AST; MD =-11.61, P=0.000) and alanine aminotransferase (ALT; MD =-18.53, P=0.000)], postoperative complication rate [relative risk (RR) =0.51, P=0.000], and 1-year survival rate (RR =1.11, P=0.000).Discussion: The application of precision surgery in the treatment of primary liver cancer can be a safe and effective method. It can minimize intraoperative blood loss, mitigate surgical risk, reduce postoperative complications, improve patient prognosis and quality of life, and provide better short-term curative effect and patient benefits.

Safety and efficacy of precision hepatectomy in the treatment of primary liver cancer

“…Precise surgical operation means that on the basis of precise pre-operative assessment and sophisticated surgical planning, the operation is carried out according to a previously drawn up plan, with a delicate operation that presupposes radical resection, grasps the concept of minimal invasion, minimizes unnecessary tissue damage and applies advanced techniques to control intraoperative bleeding [ 6 , 22 ]. Especially for complex liver resections.…”

Efficacy evaluation and prognostic risk factors analysis of precise hepatectomy in the treatment of intermediate and advanced hepatocellular carcinoma

“…In clinical practice, because the hepatic pedicle of the hepatic segment is deep, it is often difficult to dissect the corresponding hepatic pedicle before the incision of the liver tissue. Generally, only the 2nd- to 3rd-grade branches of the hepatic vascular pedicle can be controlled, and it is difficult to accurately determine a certain hepatic pedicle [16]. The ‘precise hepatectomy’ was proposed by Professor Dong Jiahong [8], a hepatectomy performed following the anatomical characteristics of the middle hepatic vein, and dedicated to improving the precision of the surgery and ensuring its effectiveness.…”

“…Preoperative evaluation has a decisive impact on the success of precise hepatectomy [19]. Preoperative evaluation includes evaluating whether the tumor could be completely removed while ensuring sufficient residual liver function, mapping the precise individual liver structure, and making plan B for unexpected reconstruction [16]. In this trial, contrast-enhanced ultrasonography was completed, simulated hepatectomy residual liver volume measurement was calculated, and CT three-dimensional angiography was constructed before precise hepatectomy [20].…”

Development and validation of nomogram to predict overall survival and disease-free survival after surgical resection in elderly patients with hepatocellular carcinoma

“…As far as hepatectomy is concerned, the methods of surgery have developed from wedge-shaped resection or conventional hepatectomy to minimally invasive and precise hepatectomy (6). The concept of Enhanced Recovery After Surgery (ERAS) put forward in recent years emphasizes the integration of preoperative individualized disease assessment, surgical plan formulation, and perioperative rehabilitation treatment to minimize surgical trauma, protect remaining liver function, and strive for the best rehabilitation effect (7).…”