title: Hepatic Re-resection Versus Transarterial Chemoembolization for the Treatment of Recurrent Hepatocellular Carcinoma after Initial Resection: a Systematic Review and Meta-analysis.
abstract: BACKGROUND
  A systematic review and meta-analysis were performed to compare the post-recurrence survival with hepatic re-resection versus transarterial chemoembolization (TACE) for recurrent hepatocellular carcinoma (HCC) after initial resection.
  
  
  METHODS
  All relevant papers were searched via PubMed, EMBASE, and Cochrane Library databases. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Subgroup analysis was performed according to country. Sensitivity analysis was performed in studies which clearly reported the recurrent regions, in moderate/high-quality studies, in studies published in full-text form, and in studies published after 2005.
  
  
  RESULTS
  In total, twelve papers were included in our study. Five and seven of them were of moderate- and poor-quality, respectively. The overall meta-analysis demonstrated a statistically significantly higher post-recurrence survival in the hepatic re-resection group than in those undergoing TACE (HR=0.64, 95%CI=0.52-0.79, P<0.0001). Heterogeneity was statistically significant and statistical significance remained in the subgroup analysis. Sensitivity analyses were also consistent with the overall analysis.
  
  
  CONCLUSIONS
  Hepatic re-resection might provide a better post-recurrence survival than TACE for recurrent HCC after initial resection. However, considering the low quality of published studies and the potential bias of treatment selection, further randomized trials should be warranted to confirm these findings.
authors.affiliation: Department of Occupational and Environmental Health Sciences and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, Xi'an, China E-mail : guo_xiao_zhong@126.com, xingshunqi@126.com.
authors.forename: Di-Ya
authors.initials: DY
authors.lastname: Wang
authors.forename: Lei
authors.initials: L
authors.lastname: Liu
authors.forename: Xing-Shun
authors.initials: XS
authors.lastname: Qi
authors.forename: Chun-Ping
authors.initials: CP
authors.lastname: Su
authors.forename: Xue
authors.initials: X
authors.lastname: Chen
authors.forename: Xu
authors.initials: X
authors.lastname: Liu
authors.forename: Jiang
authors.initials: J
authors.lastname: Chen
authors.forename: Hong-Yu
authors.initials: HY
authors.lastname: Li
authors.forename: Xiao-Zhong
authors.initials: XZ
authors.lastname: Guo
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000401:mortality*; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D015996:Survival Rate