Work

Survival and safety outcomes of hepatectomy versus ablation in hepatocellular carcinoma within Milan criteria and clinically significant portal hypertension: a systematic review and meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: BACKGROUND: The applicability and safety of hepatectomy in hepatocellular carcinoma (HCC) patients with clinically significant portal hypertension (CSPH) remain controversial. This study aimed to compare the safety and long-term outcomes of hepatectomy versus ablation in HCC patients within the Milan criteria and concomitant CSPH. MATERIALS AND METHODS: Following the PRISMA 2020 guidelines, a systematic literature search was conducted across PubMed, Cochrane, and other databases from inception to 20 April 2025. AI-assisted screening was performed using AS Review. Meta-analysis was conducted using R software (v4.4.1). Fixed-effect or random-effect models were used to calculate the comprehensive effect magnitude for overall survival (OS) and recurrence-free survival (RFS). Sparse Bayesian meta-analysis was applied to postoperative complications. Individual patient data (IPD) reconstruction validated survival outcomes. RESULTS: Seven studies (1 RCT, 6 retrospective) involving 972 patients were included. Pooled analysis showed no significant difference in OS between ablation and hepatectomy (HR = 1.10, 95% CI: 0.76-1.61, P = 0.644), but hepatectomy significantly improved RFS (HR = 2.05, 95% CI: 1.54-2.71, P < 0.001). Adjusted analyses revealed nonsignificant RFS differences (HR = 1.63, 95% CI: 0.85-3.13, P = 0.151). Subgroup analysis demonstrated superior RFS with hepatectomy versus radiofrequency ablation (HR = 2.01, 95% CI: 1.18-3.42, P = 0.008), though OS remained comparable. Notably, hepatectomy conferred dual benefits in hepatitis B virus (HBV)-related HCC for both OS (HR = 1.45, P = 0.016) and RFS (HR = 1.90, P = 0.006). IPD reconstruction further supported hepatectomy's RFS advantage (HR = 1.81, P < 0.001). Ablation was associated with lower overall complication risks, particularly a 69% reduction in ascites (OR = 0.31). CONCLUSIONS: This study suggests that the long-term survival rates of hepatectomy and ablation are comparable, but hepatectomy shows better recurrence control, especially in HBV-related cases.

Source: International Journal of Surgery

DOI: 10.1097/js9.0000000000004752