Hepatic Re-resection Versus Transarterial Chemoembolization for the Treatment of Recurrent Hepatocellular Carcinoma after Initial Resection: a Systematic Review and Meta-analysis

Background: A systematic review and meta-analysis were performed to compare the post-recurrence survivalwith hepatic re-resection versus transarterial chemoembolization (TACE) for recurrent hepatocellular carcinoma(HCC) after initial resection. Materials and
Methods: All relevant papers were searched via PubMed, EMBASE,and Cochrane Library databases. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled usinga random-effects model. Subgroup analysis was performed according to country. Sensitivity analysis wasperformed in studies which clearly reported the recurrent regions, in moderate/high-quality studies, in studiespublished in full-text form, and in studies published after 2005.
Results: In total, twelve papers were includedin our study. Five and seven of them were of moderate- and poor-quality, respectively. The overall meta-analysisdemonstrated a statistically significantly higher post-recurrence survival in the hepatic re-resection group thanin those undergoing TACE (HR=0.64, 95%CI=0.52-0.79, P<0.0001). Heterogeneity was statistically significantand statistical significance remained in the subgroup analysis. Sensitivity analyses were also consistent with theoverall analysis.
Conclusions: Hepatic re-resection might provide a better post-recurrence survival than TACEfor recurrent HCC after initial resection. However, considering the low quality of published studies and thepotential bias of treatment selection, further randomized trials should be warranted to confirm these findings.