title: Anterior vs conventional approach hepatectomy for large liver cancer: a meta-analysis.
abstract: OBJECTIVE
  To evaluate the clinical outcomes and safety of anterior- and conventional-approach hepatectomy for patients with large liver tumors.
  
  
  METHODS
  PubMed, EMBASE, Google Scholar and the Cochrane Library databases were searched for randomized controlled trials (RCTs) and controlled clinical trials comparing anterior-approach hepatectomy (AAH) and conventional-approach hepatectomy (CAH). Two observers independently extracted the data using a spreadsheet and assessed the studies for inclusion. Studies that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed using either fixed effects or random effects models.
  
  
  RESULTS
  Two RCTs and six controlled clinical trials involving 807 patients met the predefined inclusion criteria. A total of 363 patients underwent AAH and 444 underwent CAH. Meta-analysis indicated that the AAH group had fewer requirements for transfusion (OR = 0.37, 95%CI: 0.21-0.63), less recurrence (OR = 0.57, 95%CI: 0.37-0.87), and lower mortality (OR = 0.29, 95%CI: 0.13-0.63). There were no significant differences between AAH and CAH with regard to perioperative complications (OR = 0.94, 95%CI: 0.58-1.51), intraoperative tumor rupture (OR = 0.98, 95%CI: 0.40-2.40), or length of hospital stay (weighted mean difference = -0.17, 95%CI: -2.36-2.02).
  
  
  CONCLUSIONS
  AAH has advantages of decreased transfusion, mortality and recurrence compared to CAH. It is a safe and effective method for large cancers requiring right hepatectomy.
authors.affiliation: Lei Li, Hai-Qing Wang, Qing Wang, Jian Yang, Jia-Yin Yang, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Sichuan Province, Chengdu 610041, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.affiliation: Lei Li, Hai-Qing Wang, Qing Wang, Jian Yang, Jia-Yin Yang, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Sichuan Province, Chengdu 610041, China.
authors.forename: Hai-Qing
authors.initials: HQ
authors.lastname: Wang
authors.affiliation: Lei Li, Hai-Qing Wang, Qing Wang, Jian Yang, Jia-Yin Yang, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Sichuan Province, Chengdu 610041, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Lei Li, Hai-Qing Wang, Qing Wang, Jian Yang, Jia-Yin Yang, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Sichuan Province, Chengdu 610041, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Yang
authors.affiliation: Lei Li, Hai-Qing Wang, Qing Wang, Jian Yang, Jia-Yin Yang, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Sichuan Province, Chengdu 610041, China.
authors.forename: Jia-Yin
authors.initials: JY
authors.lastname: Yang
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Anterior approach; Conventional approach; Hepatectomy; Liver tumor; Meta-analysis