A Systematic Review and Meta-Analysis of Oncologic Liver Resections in Low- and Middle-Income Countries: Opportunities to Improve Evidence and Outcomes

Background: Patients in low- and middle-income countries (LMICs) are disproportionately affected by liver cancers but there is a lack of understanding of their postoperative outcomes. This study aimed to review the current status of research in LMICs regarding outcomes after oncologic hepatectomy and synthesize the data reported in the literature. Methods: The PubMed, Scopus, Embase, Web of Science, and World Health Organization (WHO) Global Index Medicus databases were searched from database inception to May 26th, 2022. Studies that reported outcomes after oncologic hepatectomy in LMIC settings were eligible for inclusion. Two independent reviewers performed record screening and data extraction. Risk of bias assessment was performed using the National Institutes of Health Study Quality Assessment tools. Pooled results with 95% confidence intervals (95% CIs) were calculated using a random effects model. Results: One hundred and thirty-five studies and 16 985 patients were included. Most studies were of a “fair” quality. Two studies described pediatric patients. Only one study was from a low-income country and most African regions were not represented. The rates of major and minor complications were 11% and 27%, respectively, while 30- and 90-day mortality rates were 2% and 3% each. Postoperative liver failure (8%), surgical site infections (6%), and bile leaks (6%) were common complications. Conclusions: This review indicates a dearth of data from LMICs on outcomes after hepatectomy, particularly from African regions and low-income countries.