Comparison Between Salvage Liver Transplantation and Repeat Liver Resection for Recurrent Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

Introduction. Repeat liver resection (RLR) has been adopted by surgeons as the first-line treatment in the case of intrahepatic recurrence of hepatocellular carcinoma (HCC), whereas salvage liver transplantation (SLT) is considered a second-line option. The aim of our study was to evaluate the results of SLT and RLR for HCC. Methods. We searched for articles published up to December 1, 2017, in the PubMed database that compared SLT with RLR for HCC. We extracted data about patient and tumor characteristics, operative and postoperative outcomes, and survival and performed a meta-analysis. Results. Patients who underwent SLT had somewhat larger liver lesions (mean difference: 0.73 cm, 95% confidence interval [CI]: 0.29-1.18, P = .001; I-2: 0%, P = .82). Moreover, salvage liver transplantation resulted in higher blood loss, longer operating time, longer hospital stay, and higher postoperative morbidity (risk ratio [RR]: 2.45, 95% CI: 1.6-3.75, P < .0001; I-2: 0%, P = .58) than RLR, whereas there was no significant difference in terms of postoperative mortality (RR: 6.48, 95% CI: 0.51-82.54, P = .15; I-2: 61%, P = .08). On the other hand, SLT led to longer disease-free survival (DFS) than RLR (HR: 0.42, 95% CI: 0.25-0.7, P = .0009; I-2: 63%, P = .03), but there was no significant difference in regard to overall survival (OS) (HR: 0.82, 95% CI: 0.55-1.23, P = .34; I-2: 0%, P = .62). Conclusions. SLT seems to be inferior to RLR regarding operative and postoperative results but presents a significant advantage in terms of DFS over RLR.