Radical surgery decreases overall morbidity and recurrence compared with conservative surgery for liver cystic echinococcosis: systematic review with meta-analysis

Background: This systematic review with meta-analysis aimed to investigate whether radical surgery (RS) for liver cystic echinococcosis (LCE) is superior to conservative surgery (CS) to decrease morbidity, mortality and recurrence. Methods: MEDLINE, Embase, the Cochrane Library, Scopus, INIST, Ovid, Science Direct, Google Scholar, Springer link, clinical key, and web of science were searched up to April 13 th , 2018. Adults of either sex operated on for symptomatic but non-complicated LCE were included. The quality of studies was assessed using the Jadad scoring system or the Methodological Index for Non-Randomized Studies index when appropriate. Meta-analyses were performed with a Mantel-Hansel method for random-effects. Results: One randomized controlled trial, one retrospective comparative study using propensity-matching analysis for comparison and 14 retrospective comparative studies were included (3,771 patients). This meta-analysis showed that there were statistically significantly fewer biliary leakage +/− fistula [odds ratio (OR) =0.35; 95% CI, 0.21–0.60, P=0.00001], overall morbidity: (OR =0.49; 95% CI, 0.40–0.59, P=0.00001), and recurrence: (OR =0.17; 95% CI, 0.11–0.26; P Conclusions: This meta-analysis showed that there were statistically significantly fewer biliary leakage +/− fistula, overall morbidity and recurrence in RS compared to CS. In the absence of large-scale RCTs, this meta-analysis suggests that RS is superior to CS in treating hydatid disease of the liver.