Comparison Of Safety And Effectiveness Of Primary Partial Hepatectomy Versus Interventional Embolization Plus Staged Partial Hepatectomy For Spontaneous Ruptured Hepatocellular Carcinoma: A Meta-analysis

Objective: Spontaneous ruptured hepatocellular carcinoma is one of the most serious fatal complications of primary liver cancer.At present,the main treatments for resectable spontaneous ruptured hepatocellular carcinoma including primary partial hepatectomy(primary hepatectomy)and interventional embolization plus staged partial hepatectomy(staged hepatectomy).Whether the two treatments are better or worse is inconclusive.This study is used to evaluate the safety and effectiveness of primary partial hepatectomy and staged partial hepatectomy in the treatment of resectable spontaneous ruptured hepatocellular carcinoma.Methods: Using the computer system to search normally used english databases such as Pubmed,Embase,Cochrane Central Register of Controlled Trials,Chinese databases such as CNKI,Wanfang,Weipu and CBM,searching time range from the establishment of the database to March 5,2020,to search all literatures on the safety and effectiveness of primary partial hepatectomy vs staged partial hepatectomy for Spontaneous ruptured hepatocellular carcinoma.Literatures were screened according to the inclusion and exclusion criteria,the quality of the included literatures was evaluated according to the Newcastle-Ottawa Scale(NOS).Meta-analysis was performed using Rev Man 5.3.Results: After screening,a total of 11 studies(4 in English and 7 in Chinese)were included.A total of 590 patients included 325 in the primary hepatectomy group and 265 in the staged hepatectomy group.The results of meta-analysis showed that compared with the primary partial hepatectomy group,The incidence of perioperative complications in the staged partial hepatectomy group was reduced[OR = 1.92,95% CI(1.12,3.29),P = 0.02],and the perioperative mortality was reduced [OR = 4.93,95 % CI(1.82,13.40),P = 0.002],2-year survival rate increased [OR = 0.53,95% CI(0.32,0.89),P = 0.02],3-year survival rate increased[OR = 0.55,95 % CI(0.38,0.79),P = 0.001],there is no statistically significant difference in the 1-year survival rate between two groups [OR = 0.71,95% CI(0.48,1.05),P = 0.08].Conclusion: For resectable spontaneous ruptured hepatocellular carcinoma,the perioperative complications and mortality in staged hepatectomy is less than that in primary hepatectomy.the 2-year and 3-year survival rate in staged hepatectomy is higher than that in primary hepatectomy,The two treatment are similar in 1-year survival rate.