title: Meta-analysis of anatomic resection versus nonanatomic resection for hepatocellular carcinoma.
abstract: OBJECTIVE
  The choice between anatomic resection (AR) versus nonanatomic resection (NAR) for hepatocellular carcinoma (HCC) is controversial. This study is a meta-analysis of the available evidence.
  
  
  METHODS
  A systematic review and meta-analysis of trials comparing AR with NAR for HCC published from 1985 to 2009 in PubMed and Medline database, Cochrane database, Embase database, and Science Citation index were conducted. Overall survival, disease-free survival, and local recurrence rate were considered as primary outcomes. Pooled effect was calculated using either the fixed effects model or random effects model.
  
  
  RESULTS
  Sixteen nonrandomized studies involving 2,917 patients were analyzed; 1,577 patients were in the AR group, and 1,340 were in the NAR group. Patients in the AR group were characterized by lower prevalence of cirrhosis and hepatitis virus infection, more favorable hepatic function, and larger tumor size compared with patients in the NAR group. AR provided a better 5-year overall survival than NAR (OR, 1.63; 95% CI, 1.15-2.32). Local recurrence (OR, 0.28; 95% CI, 0.16-0.50) and early (≤2 years) recurrence (OR, 0.55; 95 CI, 0.34-0.89) were all significantly lower in the AR group. AR improved disease-free survival significantly at 3 years (OR, 2.09; 95% CI, 1.52-2.88) and 5 years (OR, 2.24; 95% CI, 1.85-2.72). No differences were found between the two groups with respect to postoperative morbidity, mortality, and length of hospital stay.
  
  
  CONCLUSIONS
  AR was superior to NAR in terms of better survival and preventing local recurrence for the treatment of HCC.
authors.affiliation: Department of Hepato-Biliary-Pancreato-Vascular Surgery, the First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen 361003, Fujian Province, China.
authors.forename: Yanming
authors.initials: Y
authors.lastname: Zhou
authors.forename: Donghui
authors.initials: D
authors.lastname: Xu
authors.forename: Lupeng
authors.initials: L
authors.lastname: Wu
authors.forename: Bin
authors.initials: B
authors.lastname: Li
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality*; D006801:Humans; D008099:Liver / Q000033:anatomy & histology / Q000601:surgery*; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome