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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

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Front. Med.    2018, Vol. 12 Issue (3) : 350-359    https://doi.org/10.1007/s11684-017-0559-y
LETTER TO FRONTIERS OF MEDICINE |
Radical versus conservative surgical treatment of liver hydatid cysts: a meta-analysis
Qing Pang, Hao Jin, Zhongran Man, Yong Wang, Song Yang, Zongkuang Li, Yimin Lu, Huichun Liu(), Lei Zhou()
Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
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Abstract

To date, the efficacy of radical surgery (RS) versus conservative surgery (CS) for liver hydatid cysts (LHC) remains controversial. This meta-analysis was conducted to compare the two interventions. PubMed, Embase, and Web of Science were searched from their inceptions until June 2016. Meta-analysis was performed using STATA 12.0 software. We identified 19 eligible studies from 10 countries by retrieval. In total, 1853 LHC patients who received RS were compared with 2274 patients treated by CS. The risk of postoperative overall complication, biliary fistula, and recurrence was significantly lower, and operation time was significantly longer in the RS group. However, no statistically significant differences were found in terms of mortality risk and the duration of hospital stay between RS and CS. No significant publication biases were observed in all the above analyses. In conclusion, RS reduces the rates of postoperative complications and recurrence, whereas no trend toward such a reduction in mortality was observed in LHC patients.

Keywords liver hydatid cysts      radical surgery      conservative surgery      meta-analysis      complications     
Corresponding Authors: Huichun Liu,Lei Zhou   
Just Accepted Date: 04 September 2017   Online First Date: 22 November 2017    Issue Date: 04 May 2018
 Cite this article:   
Qing Pang,Hao Jin,Zhongran Man, et al. Radical versus conservative surgical treatment of liver hydatid cysts: a meta-analysis[J]. Front. Med., 2018, 12(3): 350-359.
 URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0559-y
http://academic.hep.com.cn/fmd/EN/Y2018/V12/I3/350
Fig.1  Flow chart of search strategy and study selection.
Author and publication year Period Region Design Mean follow-up (month) No. of RS and CS Mean age (year) Men Mean cyst size(cm) No. of multiple cysts Main outcomes measured NOS
score
Magistrelli, 1991 [18] 1967–1986 Italy Retro 108 64/71 46 61 12 35 Complications, recurrence, mortality 6
Gollackner, 2000 [19] 1949–1995 Austria Retro 86.4 54/20 49 26 7.3/9.7 10/1 Complications (biliary fistula, subhepatic abscess, pulmonary embolism, bleeding, deep vein thrombosis), recurrence, mortality 6
Cirenei, 2001 [20] 1950–1987 Turkey Retro 148.8 164/134 47.3 158 NR NR Complications, recurrence, mortality 6
Yorganci 2002 [21] 1992–1999 Turkey Retro 33±5.3 10/85 44 31 8.91 27 Complications, recurrence, mortality, hospital stay 6
Chautems, 2003 [22] 1980–1996 Switzerland Retro 79 57/21 40.4 30 NR NR Complications, recurrence, mortality, hospital stay 6
Yagci, 2005 [3] 1992–2003 Turkey Retro 57.4 14/171 34 114 NR 57 Complications (biliary fistula, cavity abscess, wound infection), recurrence 6
De Werra, 2007 [23] 1973–2003 Italy Retro Up to 120 178/38 8–81 98 NR 84 Recurrence, mortality, hospital stay 6
Aydin 2008 [24] 1994–2007 Turkey Retro NR 92/129 51.3/51.9 45/53 10.5/ 8.9 30/46 Complications (biliary fistula, cavity abscess, wound infection, pneumonia, pneumothorax, cardiac complication), recurrence, mortality, hospital stay 5
Priego, 2008 [25] 1983–2005 Spain Retro NR 162/210 NR NR NR NR Complications (biliary fistula, abdominal abscess), recurrence, mortality 4
Yuksel, 2008 [17] 2001–2005 Turkey Pro 15 15/17 38/41 7/6 7.8/8.1 4/7 Complications (subhepatic abscess, wound infection, pneumonia), recurrence, mortality, hospital stay, operative time 8
Akbulut, 2010 [9] 2004–2009 Turkey Retro 30.72/30.29 18/41 42.1/43.5 7/17 16.27/12.98 NR Complications (biliary fistula, atelectasis, pneumonia, wound infection), recurrence, hospital stay, operation time 6
Motie 2010 [26] 1993–2003 Iran Retro Up to 60 64/71 4–81 61 10.23/13.6 14/21 Recurrence, mortality, hospital stay, operation time 6
Secchi, 2010 [13] 1975–2007 Argentina Retro 84 396/748 NR NR NR 36/283 Complications, reinterventions, recurrence, mortality 6
Gupta, 2011 [27] 2000–2009 India Retro 28.05 61/33 39 46 8.6 38 Complications (biliary fistula, abscess), recurrence, hospital stay, operative time 6
Tagliacozzo, 2011 [28] 1980–2005 Italy Retro 87 240/214 51 152 19 158 Complications (biliary fistula, residual cavity infection, pleural effusion, pulmonary embolism, cardiac failure, respiratory failure), recurrence, mortality, hospital stay, operation time 5
Birnbaum, 2012 [7] 1991–2010 France Retro 2 85/12 38–48/46 36/4 7–10/10 7/4 Complications, recurrence, mortality, hospital stay, operative time 4
El Malki, 2014 [14] 1990–2010 Maroc Retro 106/87 85/85 NR 31/23 NR NR Complications (bleeding), reinterventions, recurrence, mortality, hospital stay 8
Salamone, 2014 [29] 2000–2011 Italy Retro NR 21/29 56.8/51.4 9/15 NR 5/11 Complications, recurrence, mortality, hospital stay 5
Georgiou, 2015 [2] 1978–2012 Italy Retro 57.6 73/145 48/50 23/58 NR NR Complications (biliary fistula, intra–abdominal abscess, deep vein thrombosis, pleural effusion, pneumonia, bleeding, pulmonary embolism), recurrence, mortality 6
Tab.1  Baseline characteristics for studies including meta-analysis
Fig.2  Comparison of postoperative overall complications (A), biliary fistula (B), residual/abdominal cavity abscess (C), and pulmonary complications (D) between radical and conservative surgery.
Fig.3  Comparison of postoperative recurrence (A) and mortality (B) between radical and conservative surgery.
Fig.4  Comparison of hospital stay (A) and operative time (B) between radical and conservative surgery.
Heterogeneity Subgroup analysis Meta-regression
Covariates Subgroup No. OR (95% CI) P I2 Q statistic P Crude P Multiple P
Publication year Before 2006 6 0.50 (0.32–0.78) 0.620 0 4.09 0.038 0.404 0.918
After 2006 12 0.28 (0.13–0.58) <0.001 90.6
Region Europe 8 0.24 (0.09–0.69) <0.001 91.7 23.47 <0.001 0.328 0.972
Others 10 0.45 (0.29–0.70) 0.056 45.7
Proportion of multiple cysts <30% 5 0.62 (0.39–0.98) 0.896 0 12.75 0.002 0.032 0.072
≥30% 7 0.13 (0.03–0.47) <0.001 92.6
Unclear 6 0.47 (0.21–1.06) <0.001 83.0
Mean cyst size (cm) <10 5 0.46 (0.25–0.87) 0.521 0 20.97 <0.001 0.519 0.974
≥10 4 0.25 (0.04–1.78) <0.001 95.3
Unclear 9 0.34 (0.19–0.61) 0.001 78.3
No. of cohort <100 8 0.39 (0.22–0.69) 0.205 28.0 0.67 0.413 0.710 NA
≥100 10 0.30 (0.14–0.64) <0.001 92.1
Follow-up(months) Median/mean≥36 or max≥72 10 0.37 (0.17–0.84) <0.001 91.2 5.09 0.024 0.545 1.000
others 8 0.27 (0.14–0.51) 0.017 59.0
Tab.2  Subgrouped analysis (by a random-effects model) and meta-regression analysis
Outcomes No. of studies Random-effects model(OR or SMD, 95% CI) Fixed-effects model(OR or SMD, 95% CI)
Overall Complications 18 0.32 (0.19–0.56) 0.29 (0.25–0.34)
Biliary fistula 11 0.24 (0.14–0.39) 0.19 (0.13–0.28)
Residual/abdominal cavity abscess 8 0.29 (0.11–0.77) 0.18 (0.12–0.28)
Pulmonary complications 6 0.67 (0.23–1.96) 0.63 (0.23–1.75)
Wound infection 4 0.43 (0.10–1.86) 0.40 (0.10–1.64)
Pleural effusion 3 0.38 (0.09–1.56) 0.35 (0.17–0.75)
Bleeding 3 0.98 (0.21–4.60) 1.00 (0.20–4.92)
Cardiovascular complications 4 1.04 (0.36–2.95) 0.93 (0.36–2.61)
Reinterventions 3 0.53 (0.08–3.35) 0.41 (0.25–0.67)
Recurrence 19 0.16 (0.11–0.23) 0.14 (0.10–0.21)
Mortality 16 0.79 (0.46–1.35) 0.82 (0.56–1.19)
Hospital stay (SMD) 6 -1.04 (-2.19–0.11) -0.69 (-0.87–-0.50)
Operative time (SMD) 3 1.51 (0.74–2.28) 1.27 (0.97–1.56)
Tab.3  Comparison between the two effects model
Fig.5  Begg’s funnel plots in terms of overall complications (A, P = 0.104), biliary fistula (B, P = 0.586), abscess (C, P = 0.308), recurrence (D, P = 0.649), mortality (E, P = 0.360), and hospital stay (F, P = 0.133).
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