Does size matter for resection of giant versus non-giant hepatocellular carcinoma? A meta-analysis

• Published in: World journal of gastrointestinal surgery Vol. 15; no. 2; pp. 273 - 286
• Main Authors: Lee, Aaron Jl, Wu, Andrew Gr, Yew, Kuo Chao, Shelat, Vishal G
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 27-02-2023
• Subjects: Meta-Analysis; Resection; Giant hepatocellular carcinoma; Hepatectomy; Meta-analysis
• ISSN: 1948-9366; 1948-9366
• DOI: 10.4240/wjgs.v15.i2.273

Research on long-term survival after resection of giant (≥ 10 cm) and non-giant hepatocellular carcinoma (HCC) (< 10 cm) has produced conflicting results.
This study aimed to investigate whether oncological outcomes and safety profiles of resection differ between giant and non-giant HCC.
PubMed, MEDLINE, EMBASE, and Cochrane databases were searched. Studies designed to investigate the outcomes of giant
non-giant HCC were included. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoints were postoperative complications and mortality rates. All studies were assessed for bias using the Newcastle-Ottawa Scale.
24 retrospective cohort studies involving 23747 patients (giant = 3326; non-giant = 20421) who underwent HCC resection were included. OS was reported in 24 studies, DFS in 17 studies, 30-d mortality rate in 18 studies, postoperative complications in 15 studies, and post-hepatectomy liver failure (PHLF) in six studies. The HR was significantly lower for non-giant HCC in both OS (HR 0.53, 95%CI: 0.50-0.55,
< 0.001) and DFS (HR 0.62, 95%CI: 0.58-0.84,
< 0.001). No significant difference was found for 30-d mortality rate (OR 0.73, 95%CI: 0.50-1.08,
= 0.116), postoperative complications (OR 0.81, 95%CI: 0.62-1.06,
= 0.140), and PHLF (OR 0.81, 95%CI: 0.62-1.06,
= 0.140).
Resection of giant HCC is associated with poorer long-term outcomes. The safety profile of resection was similar in both groups; however, this may have been confounded by reporting bias. HCC staging systems should account for the size differences.