Mansoura University, Mansoura, Egypt Can hepatic resection be advocated over the transarterial chemoembolization for patients with hepatocellular carcinoma? Hussien Ahmed 1 *, Ahmed Helal 1, Amr Menshawy 2 , Mohamed Elshahidi 3, Ahmed Negida 1 School of Medicine, Zagazig University, Zagazig, 2School of Medicine, Al-Azhar University, Cairo, 3School of Medicine, Mansoura University, Mansoura, Egypt BACKGROUND MATERIALS & METHODS RESULTS Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and the third most common cause of cancer-related death. The European Association for Study of the Liver (EASL) recommends the transarterial chemoembolization (TACE) as the first line treatment for HCC patients with intermediate stage (stage B) while hepatic resection is recommended for HCC patients with stage A. Multiple clinical studies have investigated whether the hepatic resection might achieve better survival than the TACE in HCC patients. However, results of these studies are controversial. We searched PubMed for clinical studies comparing the TACE with hepatic resection for patients with HCC. Studies were screened for eligibility and data were extracted to an online data extraction form. Overall survival rate, 1- and 5- year survival rates, and 30-day mortality rate were pooled as RR in a random ffect model meta-analysis. Subgroup analysis was performed to stratify the survival rate according to HCC stage and the status of portal vein tumor thrombus. . Statistical analysis was performed by RevMan version 5.3 for windows. Seventy-three studies (with a total of 21944 patients) were pooled in the final analysis. The overall survival rate favored the hepatic resection group than the TACE group RR 0.35, 95% CI [0.29 to 0.43]. Similarly, the one-year and fiveyear survival rates favored the hepatic resection group than the TACE group (RR 0.92 and RR 0.74, respectively). The incidence rate of mortality within 30 days from the procedure was higher in the hepatic resection group than TACE group (2.8% vs. 1.3%), however, this difference was not statistically significant. Stratification analysis showed that hepatic resection achieved better survival rate than the TACE in all HCC subgroups: Patients with stage A (RR 0.44, 95% CI [0.36 to 0.55]) (2) Patients beyond stage A (RR 0.28, 95% CI [0.19 to 0.39]) (3) Patients with portal vein tumor thrombus (RR 0.49, 95% CI [0.39 to 0.62]). OBJECTIVES CONCLUSIONS We performed this systematic review and meta-analysis to provide class one evidence about the survival rate following hepatic resection compared with the TACE for patients with HCC Our meta-analysis provides class one evidence that hepatic resection achieves better survival rate than the transarterial chemoembolization for patients with HCC within stage A and beyond stage A of the Barcelona Clinic Liver Cancer staging. REFERENCES [1] T. Xue, F. Le, R. Chen, X. Xie, L. Zhang, N. Ge, Y. Chen, Y. Wang, B. Zhang, S. Ye, Z. Ren, Transarterial chemoembolization for huge hepatocellular carcinoma with diameter over ten centimeters: a large cohort study, Medical Oncology (Northwood, London, England). 32 (2015) 64. doi:10.1007/s12032-015-0504-3. [2] D.Y. Wang, L. Liu, X.S. Qi, C.P. Su, X. Chen, X. Liu, J. Chen, H.Y. Li, X.Z. Guo, Hepatic re-resection versus transarterial chemoembolization for the treatment of recurrent hepatocellular carcinoma after initial resection: A systematic review and meta-analysis, Asian Pacific Journal of Cancer Prevention. 16 (2015) 5573–5578. doi:10.7314/APJCP.2015.16.13.5573. [3] X. Tian, Y. Dai, D.-Q. Wang, L. Zhang, C.-G. Sui, F.-D. Meng, S.-Y. Jiang, Y.-P. Liu, Y.-H. Jiang, Transarterial chemoembolization versus hepatic resection in hepatocellular carcinoma treatment: a meta-analysis., Drug Design, Development and Therapy. 9 (2015) 4431–40. doi:10.2147/DDDT.S86629. [4] X. Qi, L. Liu, D. Wang, H. Li, C. Su, X. Guo, Hepatic resection alone versus in combination with pre- and post-operative transarterial chemoembolization for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis., Oncotarget. 6 (2015). doi:10.18632/oncotarget.5426. [5] W. Liu, J.G. Zhou, Y. Sun, L. Zhang, B.C. Xing, Hepatic Resection Improved the Long-Term Survival of Patients with BCLC Stage B Hepatocellular Carcinoma in Asia: a Systematic Review and Meta-Analysis, Journal of Gastrointestinal Surgery. 19 (2015) 1271–1280. doi:10.1007/s11605-015-2811-6. [6] T. Kapitanov, U.P. Neumann, M. Schmeding, Hepatocellular Carcinoma in Liver Cirrhosis: Surgical Resection versus Transarterial Chemoembolization—A Meta-Analysis, Gastroenterology Research and Practice. 2015 (2015) 1–8. doi:10.1155/2015/696120.