A systematic review 1 including 14 studies of resection with a total of 3 153 subjects was abstracted in DARE. There were 12 case series and two studies comparing two treatment strategies. Eight studies of liver transplantation without adjuvant chemotherapy (433 participants), seven studies of liver transplantation with adjuvant systemic or local chemotherapy (206 participants) and fourteen studies with non-surgical methods for disease controll were included. In resection, long-term survival is limited because of tumour recurrence and progression of liver disease (actual survival rates at 1, 3, and 5 years were 62 to 90%, 35 to 75%, and 17 to 53%). The recurrence rate ranged from 28% to 78% at 1 - 5 years following treatment. Ethanol injections seem to be advantageous in small carcinomas in patients with poor hepatic reserve. Systemic chemotherapy has response rates of less than 20%. Targeted regional chemotherapy using transcatheter arterial embolisation appears to be more effective. In liver transplantation without adjuvant chemotherapy the results were disappointing (1, 3, and 5-year survival rates ranged from 40 to 90%, 21 to 77%, and 21 to 36%). The recurrence rate ranged from 4 to 67% at 1 - 5 years following treatment. In liver transplantation with adjuvant chemotherapy the results were good (actual survival rates at 1, 3, and 5 years ranged from 70 to 100%, 46 to 85%, and 81% (only 1 study). The recurrence rate ranged from 1 to 8% at 1 - 5 years following treatment.
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by by indirectness (differences in studied interventions).
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