title: Efficacy of radical and conservative surgery for hepatic cystic echinococcosis: a meta-analysis.
abstract: OBJECTIVE
  To systematically evaluate the efficacy and safety of radical surgery (RS) and conservative surgery (CS) in the treatment of hepatic cystic echinococcosis (HCE).
  
  
  METHODS
  We searched PubMed, Embase, MEDLINE, SCI, CNKI, CBM, and WanFang databases, and the Cochrane Library (2013, Issue 3) for references published before December 2013. Both randomized and non-randomized controlled trials of radical and conservative surgery for HCE were collected. After the literature was screened in accordance with inclusion and exclusion criteria, data were extracted and the quality of methodologies of selected references was determined independently by two evaluators. A meta-analysis was performed on eligible studies with RevMan 5.1 statistical software.
  
  
  RESULTS
  Five non-randomized controlled trials (1267 patients) were included in this study. Patients in the RS group had fewer postoperative complications compared with the CS group [OR = 0.42, 95% CI (0.32, 0.56), P < 0.00001], whereas there was no significant difference in rates of postoperative bile leakage between the two groups [OR = 0.22, 95% CI (0.05, 1.12), P = 0.07]. Postoperative follow-up of patients revealed a significantly lower HCE recurrence rate in the RS versus CS group [OR = 0.17, 95% CI (0.08, 0.38), P < 0.0001]. Additionally, no statistical differences in the number of days of hospitalization [MD = -2.47, 95% CI (-6.42, 1.49), P = 0.22] and perioperative mortality [OR = 0.87, 95% CI (0.27, 2.79), P = 0.82] were identified between groups.
  
  
  CONCLUSIONS
  RS, especially total pericystectomy, has obvious advantages over CS: fewer complications, lower postoperative recurrence, and a lower incidence of biliary fistula and infection, making RS the preferred surgical method. This conclusion requires further validation with high-quality RCTs with large sample sizes. Surgical approach should be based upon comprehensive assessment of individual circumstances in HCE patients.
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University 137 Liyushan Road, Xinshi District, Urumqi 830054, Xinjiang, China.
authors.forename: Yi-Biao
authors.initials: YB
authors.lastname: He
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University 137 Liyushan Road, Xinshi District, Urumqi 830054, Xinjiang, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Yao
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University 137 Liyushan Road, Xinshi District, Urumqi 830054, Xinjiang, China.
authors.forename: Tuerhongjiang
authors.initials: T
authors.lastname: Tuxun
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University 137 Liyushan Road, Xinshi District, Urumqi 830054, Xinjiang, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Bai
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University 137 Liyushan Road, Xinshi District, Urumqi 830054, Xinjiang, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University 137 Liyushan Road, Xinshi District, Urumqi 830054, Xinjiang, China.
authors.forename: Jin-Ming
authors.initials: JM
authors.lastname: Zhao
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University 137 Liyushan Road, Xinshi District, Urumqi 830054, Xinjiang, China.
authors.forename: Jin-Hui
authors.initials: JH
authors.lastname: Zhang
authors.affiliation: Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University 137 Liyushan Road, Xinshi District, Urumqi 830054, Xinjiang, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wen
keywords: Hepatic cystic echinococcosis; conservative surgery; endocystectomy; radical surgery; total pericystectomy