Impact of intraoperative vascular occlusion during liver surgery on long-term outcomes: A systematic review and meta-analysis

Objective: To determine the impact of intraoperative vascular occlusion during liver surgery on postoperative long-term outcomes for hepatocellular carcinoma (HCC) patients using a meta-analysis. Methods: A systematic literature search of PubMed, EMBASE, and Cochrane Central was conducted to discover relevant randomized controlled trials (RCTs) and observational studies. Studies that reported postoperative long-term outcomes; 1-, 3-, and 5-year overall survival (OS); and/or 1-, 3-, and 5-year recurrence-free survival (RFS) for both an observation group (vascular occlusion) and a control group (vascular non-occlusion) were included. Forest plots were performed to calculate the difference between the 2 groups. The Q statistic and the I-2 index statistic were used to assess heterogeneity. Publication bias was evaluated using Egger's test. Results: Four observational studies containing 2917 patients were included in this meta-analysis. The pooled estimation results indicated that intraoperative vascular occlusion would not shorten the postoperative OS (RR = 1.01; 95%CI: 0.98-1.03; P = 0.763) and would not increase the risk of HCC recurrence (RR = 0.99; 95%CI: 0.97-1.02; P = 0.320) with low heterogeneity (I-2 = 0.0% and 12.7%, respectively). Furthermore, Egger's test did not reveal any publication bias (P = 0.405 and P = 0.269, respectively) in this research. Conclusions: Intraoperative vascular occlusion during liver surgery is safe for HCC patients. It does not affect the postoperative overall survival or increase the risk of HCC recurrence. (C) 2017 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.