Background and Aims: Salvage liver transplantation (SLT) versus repeat hepatectomy (RH), which one is more beneficial to patients with recurrent hepatocellular carcinoma after primary resection is still inconclusive, and has no verification from the large multicenter clinical trials as well at present time. This study was aimed to evaluate the clinical efficacy of LT and RH for recurrent hepatocellular carcinoma after hepatectomy through a Meta-analysis, so as to provide reference for treatment selection of this condition.
Methods: The clinical studies comparing efficacy of SLT versus RH in treatment of recurrent hepatocellular carcinoma after hepatectomy were collected by searching several national and international databases in the time period from the inception of the databases to August 2019. After literature screening, data extraction and quality assessment conducted by two independent reviewer, Meta-analysis was performed using the overall survival rate and disease-free survival rate as the main outcome variables.
Results: Six retrospective cohort studies meeting the inclusion criteria were finally included, involving 650 patients with 134 case in SLT group and 516 case in RH group. Results of Meta-analysis showed that the 1- and 3-year overall survival rates had no statistically significant difference between SLT group and RH group (OR=1.70, 95% CI=0.82–3.53, P=0.15; OR=1.10, 95% CI=0.70–1.72, P=0.67), but the 5-year overall survival rate in SLT group was significantly superior to that in RH group (OR=1.56, 95% CI=1.03–2.37, P=0.04); the 1-, 3- and 5- year disease-free survival rates in SLT group were all significantly to those in RH group (OR=5.91, 95% CI=3.16–11.05, P<0.000 01; OR=3.98, 95% CI=2.57–6.16, P<0.000 01; OR=4.37, 95% CI=2.03–9.44, P=0.000 2). The incidence of postoperative complications in SLT group was significantly higher than that in the RH group (OR=4.67, 95% CI=2.72–8.01, P<0.000 01). There was no significant difference in perioperative mortality between the two groups (OR=3.92, 95% CI=0.41–37.80, P=0.24). The intraoperative blood loss was significantly higher and the length of hospital stay were significantly longer SLT group than those in the RH group (both P<0.05). 
Conclusion: SLT is a safe and effective approach for postoperative recurrent hepatocellular carcinoma. Compared to RH, SLT can significantly improve postoperative disease-free survival rate and obtain a better long-term prognosis. However, considering the shortage of liver donor, RH is still an important treatment for postoperative recurrent hepatocellular carcinoma.