Efficacy and Safety of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Versus Two-Stage Hepa
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ORIGINAL ARTICLE
Efficacy and Safety of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Versus Two-Stage Hepatectomy: a Systematic Review and Meta-analysis Gang Yin 1 & Weihua Zhu 2 & Zhipeng Sun 1 & Amin Buhe 1 & Peirong Tian 1 & Jirun Peng 1 Received: 14 May 2020 / Accepted: 9 October 2020 # Association of Surgeons of India 2020
Abstract Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been widely used in recent years. However, the clinical outcomes of ALPPS compared with that of two-stage hepatectomy (TSH) remain controversial. This meta-analysis aimed to compare the safety and efficacy of ALPPS and TSH. Relevant studies were retrieved via a search of the “MEDLINE,” “EMBASE,” and “SCIENCE DIRECT” databases. A meta-analysis of the mortality rate, second surgery completion rate, and future remnant liver regeneration rate was performed using the fixed-effects and random-effects models. A total of five studies were assessed that included 332 patients in the TSH group and 103 in the ALPPS group. The overall mortality rate in the ALPPS group (61.4%) was significantly higher as compared with that in the TSH group (39.1%) (χ2 = 11.23; Z = 4.77; P < 0.0001). The second surgery completion rate in the ALPPS group (92.2%) was significantly higher as compared with that in the TSH group (75.9%) (χ2 = 2.33; Z = 3.53; P = 0.0004). The average future remnant liver regeneration rate in the ALPPS group (69.5%) was significantly greater as compared with that in the TSH group (48.3%) (χ2 = 51.05; Z = 10.56; P < 0.0001). ALPPS can promote future liver regeneration, while TSH is associated with a lower mortality rate. The safety of ALPPS needs to be improved in further studies. Keywords Associating liver partition and portal vein ligation for staged hepatectomy . Portal vein embolization . Two-stage hepatectomy . Liver regeneration
Introduction Conventional two-stage hepatectomy (TSH) was first reported in 2000 in the surgical treatment of patients with bilateral multinodular colorectal liver metastases [1]. The major drawback of conventional TSH procedures is the low future remnant liver regeneration rate that is generally < 50% for 4–8 weeks [2]. The TSH technique is mainly divided into first-stage hepatectomy, PVE, and secondstage hepatectomy. The first-stage hepatectomy is a key step of the planned procedure. It consists in a complete clearance of the metastases located in one hemiliver. In most cases, the FRL is the left hemiliver. The first-stage * Jirun Peng [email protected] 1
Department of Surgical Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
2
Peking University People’s Hospital, Beijing 100034, China
hepatectomy included non-anatomic liver resections either associated or not associated with radiofrequency (RF) destruction. A right PVE (with or without branches of segment IV) is performed 2–5 weeks after the first-stage hepatectomy. A percutaneous approach through the left portal branch is routinely used. L
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