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BACKGROUND: Liver transplantation(LT) and liver resection(LR) are currently considered the standard treatment of patients with hepatocellular carcinoma(HCC). However, the outcomes of LT and LR are still inconclusive.DATA SOURCES: MEDLINE, EMBASE, and Cochrane Library were searched for relevant studies. Surgical safety indices such as treatment-related morbidity and mortality, and efficacy indices such as overall and tumor-free survival outcomes were evaluated. Weighted mean differences and odds ratios(ORs)were calculated using a random-effects model.RESULTS: Seventeen studies were included in this metaanalysis.LT achieved significantly higher rates of surgeryrelated morbidity(OR=1.47; 95% CI: 1.02-2.13) and mortality(OR=2.12; 95% CI: 1.11-4.05). Likewise, the 1-year survival rate was lower in LT(OR=0.86; 95% CI: 0.61-1.20). However, the 3-and 5-year survival rates were significantly higher in LT than in LR and the ORs were 1.12(95% CI: 0.96-1.30) in 3 years and1.84(95% CI: 1.49-2.28) in 5 years. Furthermore, the tumorfree survival rate in LT was significantly higher than that in LR in 1, 3, 5 years after surgery, with the ORs of 1.72(95% CI:1.24-2.41), 3.75(95% CI: 2.94-4.78) and 5.64(95% CI: 4.35-7.31),respectively.CONCLUSIONS: One-year morbidity and mortality are higher in LT than in LR for patients with HCC. However, long-term survival and tumor-free survival rates are higher in patients treated with LT than those treated with LR.
BACKGROUND: Liver transplantation (LT) and liver resection (LR) are currently considered the standard treatment of patients with hepatocellular carcinoma (HCC). However, the outcomes of LT and LR are still inconclusive. DATA SOURCES: MEDLINE, EMBASE, and Cochrane Library Surgical safety indices such as treatment-related morbidity and mortality, and efficacy indices such as overall and tumor-free survival results were were evaluated. Weighted mean differences and odds ratios (ORs) were calculated using a random-effects model . RESULTS: Seventeen studies were included in this metaanalysis. LT achieved significantly higher rates of surgery-related morbidity (OR = 1.47; 95% CI: 1.02-2.13) and mortality (OR = 2.12; 95% CI: 1.11-4.05) the 1-year survival rate was lower in LT (OR = 0.86; 95% CI: 0.61-1.20). However, the 3-and 5-year survival rates were significantly higher in LT than in LR and the ORs were 1.12 % CI: 0.96-1.30) in 3 years and 1.84 (95% CI: 1.49-2.28) i n 5 years. Furthermore, the tumor survival rate in LT was significantly higher than that in LR in 1, 3, 5 years after surgery, with the ORs of 1.72 (95% CI: 1.24-2.41), 3.75 (95% CI: 2.94-4.78) and 5.64 (95% CI: 4.35-7.31), respectively. CONCLUSIONS: One-year morbidity and mortality are higher in LT than in LR for patients with HCC. However, long-term survival and tumor-free survival rates are higher in patients treated with LT than those treated with LR.