Associating liver partition and portal vein ligation for staged hepatectomy versus conventional two-stage hepatectomy: a systematic review and meta-analysis

Abstract

BackgroundIt is generally accepted that an insufficient future liver remnant is a major limitation of large-scale hepatectomy for patients with primary hepatocellular carcinoma. Conventional two-stage hepatectomy (TSH) is commonly considered to accelerate future liver regeneration despite its low regeneration rate. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), which is characterized by a rapid regeneration, has brought new opportunities.MethodsRelevant studies were identified by searching the selected databases up to September 2017. Then, a meta-analysis of regeneration efficiency, complication rate, R0 resection ratio, and short-term outcomes was performed.ResultsTen studies, comprising 719 patients, were included. The overall analysis showed that ALPPS was associated with a larger hyperplastic volume and a shorter time interval (P < 0.00001) than TSH. ALPPS also exhibited a higher completion rate for second-stage operations (odds ratio, OR 9.50; P < 0.0001) and a slightly higher rate of R0 resection (OR 1.90; P = 0.11). Interestingly, there was no significant difference in 90-day mortality between the two treatments (OR 1.44; P = 0.35).ConclusionsThese results indicate that compared with TSH, ALPPS possesses a stronger regenerative ability and better facilitates second-stage operations. However, the safety, patient outcomes, and patient selection for ALPPS require further study.Electronic supplementary materialThe online version of this article (10.1186/s12957-017-1295-0) contains supplementary material, which is available to authorized users.

Novel Techniques in the Surgical Management of Hepatocellular Carcinoma

“…Although ALPPS had lower 1-year DFS rate, no significant difference in the 90-day mortality rate was discovered comparing the two techniques [66]. ALPPS was associated with a higher completion rate, a lower probability of tumor progression during the stage interval, and a lower insufficient regeneration rate; these findings are similar to those of previous studies [56,67,68].…”

“…It has been reported that postoperative morbidity and mortality after ALPPS are 16-64 and 12-23%, respectively, with the main cause of morbidity being bile leakage and sepsis and the main cause of mortality being PHLF [66,67]. In the latest systematic review and meta-analysis by Zhou et al, 719 patients were included, and the aim was to compare the regeneration efficiency, safety, and complication rates of ALPPS and TSH.…”

Current topics in liver surgery

“…In the first ALPPS procedures, intraoperative blood loss to partition the liver parenchyma was too high, ranging from 100 to 725 mL. Meta‐analysis confirmed the results of operation‐related outcomes . This procedure is therefore considered to be under development and modifications of the procedure and revision of its indications will be required in order to improve safety.…”

Innovative Surgical Approaches for Locally Advanced Hepatic Malignancy

“…15 Reports of postoperative morbidity and mortality following ALPPS are 16 to 64 and 12 to 23%, respectively, with the main cause of morbidity being bile leakage and sepsis and the main cause of mortality being PHLF. 16,17 Zhou et al reviewed 719 patients comparing the regeneration efficiency, safety, and complication rates of ALPPS and TSH. The degree of FLR regeneration in ALPPS was significantly higher and the interval of the two stages in ALPPS was shorter.…”