Department of Abdominal Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, 200032 Shanghai, People's Republic of China.
Dig Dis Sci. 2011 Jun;56(6):1626-33. doi: 10.1007/s10620-010-1482-0. Epub 2010 Nov 17.
To compare the effect on survival of anatomic resection (AR) versus nonanatomic resection (NAR) in patients with hepatocellular carcinoma (HCC) from all published comparative studies in the literature.
Databases, including Pubmed, Embase, the Cochrane Library, Ovid, and Web of Science, were searched to identify studies comparing AR with NAR for HCC. In this meta-analysis, primary end points were the overall survival and disease-free survival; the secondary end point was local recurrence rate. The meta-analysis was performed by use of RevMan 4.2.
Nine comparative studies comprising 1,503 patients (833 AR and 670 NAR) were identified. In the combined results, disease-free survival was significantly higher in the AR group than in the NAR group (OR 1.78, 95% CI 1.22-2.59, P = 0.003; heterogeneity P = 0.08). Overall survival (OR 1.31, 95% CI 0.92-1.85, P = 0.13; heterogeneity P = 0.04) did not suggest any significant difference between AR and NAR. No statistically significant difference was found for local recurrence rate between the two resection methods (OR 0.55, 95% CI 0.25-1.23, P = 0.15; heterogeneity P = 0.010).
Anatomic resection is associated with better disease-free survival than nonanatomic resection. Because heterogeneity was detected, caution is needed in interpretation of the results. Better designed, adequately powered studies are required to address this issue.
比较所有已发表的文献中比较解剖性肝切除术（AR）与非解剖性肝切除术（NAR）治疗肝细胞癌（HCC）患者的生存效果。
检索 Pubmed、Embase、Cochrane 图书馆、Ovid 和 Web of Science 等数据库，以确定比较 AR 与 NAR 治疗 HCC 的研究。本荟萃分析的主要终点为总生存时间和无病生存时间；次要终点为局部复发率。使用 RevMan 4.2 进行荟萃分析。
共纳入 9 项比较研究，包括 1503 例患者（833 例 AR 和 670 例 NAR）。综合结果显示，AR 组的无病生存率明显高于 NAR 组（OR 1.78，95%CI 1.22-2.59，P = 0.003；异质性 P = 0.08）。总生存时间（OR 1.31，95%CI 0.92-1.85，P = 0.13；异质性 P = 0.04）提示 AR 与 NAR 之间无显著差异。两种切除方法的局部复发率无统计学差异（OR 0.55，95%CI 0.25-1.23，P = 0.15；异质性 P = 0.010）。
与非解剖性肝切除术相比，解剖性肝切除术可获得更好的无病生存时间。由于存在异质性，对结果的解释需谨慎。需要设计更好、样本量更大的研究来解决这一问题。
