Abstract:
Background: Vascular inflow control is a critical step during hepatectomy, with both extrahepatic hilar dissection (Extrahepatic) and Glissonian sheath ligation (Glissonian) described. Data are conflicting on which method is superior. The objective of this review was to systematically compare the safety and oncologic efficacy of Extrahepatic versus Glissonian techniques during major hepatectomy. Method: A literature search was performed using MEDLINE, CENTRAL and EMBASE until April 2014. Included studies had to provide a comparison between Extrahepatic and Glissonian techniques. Both randomized trials and observational studies were included. Studies were assessed for methodological quality. The outcomes included for analysis were operative duration, total blood loss, blood transfusion rate, length of stay, bile leak, R0 rate, and in-hospital or 30 day mortality. A random effects model was used for all meta-analyses to provide estimates of the average treatment effect, presented as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (95% CI). Results: The search identified 1468 articles, of which 8 were included in the analysis, comprising one randomized trial and seven observational studies. These included 2028 patients, with 842 (41.5%) in the Extrahepatic group and 1186 (58.5%) in the Glissonian group. There was less blood loss (MD 67.82 mL; 95% CI 15.5, 120.1), and a trend toward shorter operative duration (MD 22.5 minutes; 95% CI -6.4, 51.7) in the Glissonian group. Blood transfusion rate, length of stay, bile leak rate, R0 rate, and mortality rate did not differ between the groups. Conclusions: Both Extrahepatic and Glissonian techniques may be safely used during major hepatectomy, with equivalent R0 resection rates. However, it appears that the Glissonian technique is associated with less blood loss and shorter operative duration, although the differences are small and may not be clinically relevant.