Liver Transplantation Versus Resection for Hepatocellular Carcinoma: An Umbrella and Meta-Meta-Analysis of Published Evidence, 2000–2025

This umbrella synthesis demonstrates that LT provides superior long-term OS and DFS compared with LR for HCC, with consistent robustness across both Milan and extended selection criteria. Methodological safeguards against study overlap and subgroup insights-including intention-to-treat analyses, viral etiology (hepatitis B virus/hepatitis C virus), era, and geographic region-reinforce LT as the preferred strategy for eligible patients, while LR remains a critical option where graft availability is limited.