Abstract
Background: This study evaluated the feasibility, safety and effectiveness in patients treated with associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and portal vein embolization (PVE) for the treatment of liver malignant tumors with insufficient future liver remnant (FIR). Method: We performed a computer search on the PubMed databases to retrieve the RCT or clinical trials comparing ALPPS and PVE published from January 2010 to January 2020. The quality of the included trials was assessed according to the inclusion and exclusion criteria by two researchers independently. The RevMan 5.3 and STATA 12.0 software were used to extract and analyze the data. Result: A total of 11 retroprospective clinical trial articles comprising 867 patients were included in the study. The number of patients who underwent ALPPS were 247 and 620 for PVE. There were significant differences (P <0.05) in the second stage hepatectomy［OR=11.25, 95%CI: 5.64~22.43, Z=6.87, P＜0.001］, the sufficient FLR growth［MD=46.85, 95% CI:4~89.70, Z=2.41, P=0.03］, the time to stage II operation (MD=-22.85, 95% CI:-33.87~-11.84, Z=4.07, P＜0.001) and rate of R0 resection［OR=2.29, 95%CI: 1.07~4.90, Z=2.13, P=0.03］between the two groups. However, no significant differences were observed between ALPPS and PVE in terms of mortality within 90 days of perioperative period, overall postoperative complication rate, incidence of postoperative liver failure and postoperative hospital stay (P＞0. 05). Conclusion: Compared with PVE, The ALPPS procedure was associated with good postoperative outcomes with insufficient FLR. However, the clinical application of ALPPS and PVE has some limitations. Large, multicenter prospective randomized controlled trials are needed to validate these findings.
Comparison of functional and volumetric increase of the future remnant liver and postoperative outcomes after portal vein embolization and complete or partial associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)
