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 13th, 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<0.00001) in RS compared to CS. 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.
