A Meta-analysis Of Safety And Efficacy Of Associating Liver Partition And Portal Vein Ligation For Staged Hepatectomy(ALLPPS)versus Portal Vein Embolization After Stage Hepatectomy(PVE)

Objective : To evaluate the efficacy and safety of ALPPS and PVE in partial hepatectomy,and to provide a theoretical basis for the choice of surgical methods for patients with insufficient residual liver volume.Methods : The clinical data of ALPPS and PVE were collected from Pubmed,Medline,Cochrane library,Embase,WOS-SCI,CMB,CNKI and VIP.The retrieval time was based on the inclusion and elimination criteria.The retrieved literature was screened and the extracted literature was used to extract the relevant data.The quality of the literature was evaluated and analyzed using the review manager 5.3 software team data.Results:Finally,7 clinical trials were included,a total of 525 patients,including 126 cases of ALPPS group,399 cases of PVE group.The results of the general analysis are as follows:(1)The proliferative rate of FLR,the statistical difference between ALPPS group and PVE group(MD = 10.06,95% CI = 7.60-13.61,P<0.00001);(2)There was significant difference in FLR daily growth rate between FLP group and PVE group(MD = 31.54,95% CI = 29.14-33.99,P <0.00001).(3)The rate of completion of two-step hepatectomy was statistically different in the ALPPS and PVE groups(RR = 9.34,95% CI = 2.54-34.37,P = 0.0008).(4)There was no significant difference between the ALPPS group and the PVE group(RR = 1.37,95%CI = 0.93-2.03,P = 0.12).(5)There was no significant difference in postoperative sepsis between postoperative sepsis,ALPPS group and PVE group(RR = 8.56,95%CI = 0.24-303.45,P = 0.24).(6)There was no significant difference in postoperative bile leakage,postoperative bile leakage rate between ALPPS group and PVE group(RR = 2.12,95% CI = 1.00-4.50,P = 0.05).(7)There was no significant difference between ALPPS group and PVE group(RR = 0.85,95% CI = 0.38-1.89,P =0.69).(8)There was a significant difference between the ALPPS group and the PVE group(MD =-23.45,95% CI =-28.90--18.01,P <0.00001).(9)R0 resection rate,ALPPS group and PVE group R0 resection rate was statistically significant(RR =2.99,95% CI = 1.33-6.75,P = 0.008).(10)There was no significant difference in 90 daily mortality between the ALPPS group and the PVE group(RR = 1.94,95% CI =0.85-4.39,P = 0.11).Conclusion:ALPPS operation group and PVE group in the FLR growth rate,daily FLR growth rate,two-step liver resection surgery completion rate,hospital day,R0 resection in the ALPPS group than PVE group;in the total postoperative complications,postoperative sepsis,Postoperative bile leakage,liver failure,90-day mortality in both no significant statistical differences.