Related Experiment Video
Updated: Jan 13, 2026
Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy
Published on: March 10, 2023
Liver Transplantation Versus Resection for Hepatocellular Carcinoma: An Umbrella and Meta-Meta-Analysis of Published
Seoung Hoon Kim1, Byeong Ho An1, Jin A Lee1
1Organ Transplantation Center, National Cancer Center, Korea 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si 10408, Gyeonggi-do, Republic of Korea.
Background:
Multiple meta-analyses have compared liver resection (LR) with liver transplantation (LT) for hepatocellular carcinoma (HCC), but overlapping primary studies and heterogeneous outcome definitions have complicated interpretation.
Methods:
A PRISMA/PRIOR-compliant umbrella review (PROSPERO CRD420251069248) was conducted. PubMed, Embase, and CENTRAL were searched for meta-analyses published between 1 January 2000 and 30 September 2025. Quantitative meta-analyses comparing LT and LR were included, while one systematic review of meta-analyses was synthesised narratively. Effect directions were standardised; hazard ratio (HR)-based summaries (LR:LT; values > 1 favour LT) were pooled using random-effects models, whereas odds ratio (OR)-based summaries were described qualitatively because of heterogeneity in endpoint definitions.
Results:
Four quantitative meta-analyses and one systematic review of meta-analyses met the inclusion criteria. Pooled HRs confirmed LT superiority: overall survival (OS) HR 1.35 (95% CI 1.17-1.55) and disease-free survival (DFS) HR 2.58 (95% CI 2.25-2.96). OR-based summaries from recent meta-analyses were directionally consistent but were not pooled.
Conclusions:
This umbrella synthesis demonstrates that LT provides superior long-term OS and DFS compared with LR for HCC, with consistent robustness across both Milan and extended selection criteria. Methodological safeguards against study overlap and subgroup insights-including intention-to-treat analyses, viral etiology (hepatitis B virus/hepatitis C virus), era, and geographic region-reinforce LT as the preferred strategy for eligible patients, while LR remains a critical option where graft availability is limited.
