title: Systematic review and meta-analysis of adjuvant i(131) lipiodol after excision of hepatocellular carcinoma.
abstract: BACKGROUND
  Curative resection for hepatocellular carcinoma (HCC) has an 80 % recurrence at 5 years. Survival could be prolonged with adjuvant iodine(131) lipiodol. This systematic review and meta-analysis was designed to assess the survival benefit of this treatment in patients with resected HCC compared with surgery alone.
  
  
  METHODS
  Studies were identified through a systematic search of MEDLINE, EMBASE, PubMed, and Cochrane databases in June 2013. Three case-control series and two randomized, controlled trials (RCT) were included. Two of these studies had a second publication that analyzed long-term follow-up. Two reviewers extracted data with respect to disease-free and overall survival (OS). The data from the seven studies was then subject to meta-analysis.
  
  
  RESULTS
  Age, sex, liver function, tumor size, encapsulation, microvascular invasion, multifocality, and the rate of major hepatic resection were similar in the two groups. Peto odds ratio for disease-free survival was 0.47 (95 % confidence interval (CI) 0.37-0.59, I (2 )= 10 %) and for OS was 0.5 (95 % CI 0.39-0.64, I (2 )= 37 %), in favor of treatment.
  
  
  CONCLUSIONS
  This study is limited by its comparison of two RCTs with three case-control studies. Most patients also had preserved liver function, and there was a generally low rate of microvascular invasion. Nonetheless, there is strong evidence for the use of adjuvant I(131) lipiodol, to prolong disease-free and OS, up to 5 years after resection.
authors.affiliation: Upper Gastrointestinal Surgery and Transplant unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia, ruelanfurtado@yahoo.co.uk.
authors.forename: Ruelan
authors.initials: R
authors.lastname: Furtado
authors.forename: Michael
authors.initials: M
authors.lastname: Crawford
authors.forename: Charbel
authors.initials: C
authors.lastname: Sandroussi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004998:Ethiodized Oil / Q000627:therapeutic use*; D006498:Hepatectomy; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate
chemical_list: D007457:Iodine Radioisotopes; D004998:Ethiodized Oil