Clinical Efficacy Of ALPPS And PVE-based Two-stage Hepatectomy In Treatment Of Liver Cancer With Insufficient FLR:A Meta-analysis

Objective:Systematically evaluate the clinical efficacy of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)compared with portal vein embolization(PVE)-based two-stage hepatectomy in the treatment of future liver cancer with insufficient future liver remnant(FLR),providing evidence-based medical evidence for clinicians.Methods:All literatures comparing the clinical efficacy of ALPPS and PVE-based two-stage hepatectomy in the treatment of liver cancer with insufficient FLR were searched in Pub Med,Web of Science,Embase,Cochrane,CNKI,Wanfang and VIP databases from database establishment to September 2021.The literatures were screened according to the established inclusion and exclusion criteria,and the data were extracted.Meta-analysis was performed using Rev Man 5.3.Results:A total of 17 articles containing 1145 patients(385 in the ALPPS group and 760 in the PVE group)were included.Meta-analysis showed that there were significant differences between the two groups in FLR growth rate(MD = 20.04,95% CI: 11.59 ～28.48,Z = 4.65),second-stage surgical resection rate(OR = 9.62,95% CI: 5.35 ～ 17.28,Z = 7.57),two-phase processing interval(MD =-34.48,95% CI:-36.52 ～-32.45,Z =33.17)and R0 resection rate(OR = 2.01,95% CI: 1.05 ～ 3.83,Z = 2.11)(P < 0.05).ALPPS group could significantly improve FLR growth rate,second-stage surgical resection rate,R0 resection rate and shorten two-phase processing interval.There was no significant difference between the two groups in terms of 90-day mortality(OR = 1.38,95% CI: 0.79 to 2.39,Z = 1.14,P > 0.05),postoperative liver failure rate(OR = 0.93,95% CI: 0.55 to 1.58,Z = 0.26,P > 0.05),overall complication rate(OR = 1.10,95% CI:0.60 to 2.00,Z = 0.31,P > 0.05),and 3-year survival rate(OR = 1.05,95% CI: 0.44 to2.54,Z = 0.11,P > 0.05).Conclusion:Compared with PVE-based two-stage hepatectomy,ALPPS can significantly improve the second-stage surgical resection rate,R0 resection rate and shorten the two-phase processing interval in patients with FLR-insufficient liver cancer.There was no significant difference in 90-day mortality,postoperative liver failure rate,overall complication rate and 3-year survival rate between the two groups.Therefore,under strict preoperative evaluation,ALPPS is safe and effective compared with PVE-based two-stage hepatectomy in the treatment of patients with FLR-insufficient liver cancer.