Meta-analysis Of The Outcomes Of Associating Liver Partition And Portal Vein Ligation For Staged Hepatectomy(ALPPS)versus Portal Vein Embolization(PVE)for The Treatment Of Liver Cancer With Insufficient Future Liver Remnant(FLR)

Objective:To explore the advantages of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)vs portal vein embolization(PVE)and the feasibility,safety and efficacy of the two stage liver resection methods for the treatment of liver cancer with insufficient future liver remnant(FLR).Methods:The literatures were searched from a large range of datebases of Pubmed,Cochrane Library,Embase,CNKI,and VIP using both subject headings(MeSH)and truncated word to indentify all of the articles published that related to this topic.The clinical data of ALPPS and PVE were extracted,including perioperative two-staged operation rate,perioperative FLR hyperplasia rate,two-step surgery interval time,perioperative radical resection rate,perioperative mortality within 90 days,perioperative complications,perioperative liver failure,total hospital stay and other related indicators.The statistical analysis wasperformed using the Revman manager 5.3 for meta-analysis.Results:There were 10 literatures with clinical control were analyzed(9cohort studies and 1 randomized controlled study).A total of 620 patients were included,metastatic liver cancer accounted for 79.7%(494/620),primary liver cancer accounted for 9.2%(57/620),and other types accounted for 11.1%(69/620),including 165 cases in ALPPS group,455 cases in PVE group.ALPPS group of men 63% vs PVE group 66%,gender distribution was no significant difference,p> 0.05.ALPPS mean age 61 years vs PVE group of 62,the age distribution was no significant difference,p> 0.05.The results were analyzed as follow: 1)Perioperative two-staged operation rate was 95.8% in ALPPS group and 76.5% in PVE group.The difference between the two groups was statistically significant(OR = 6.04,95% CI = 2.97-12.31,Z = 4.96,p <0.00001).2)Perioperative FLR hyperplasia rate was 56.5% in ALPPS group and35.6% in PVE group.The difference between the two groups was statistically significant(MD = 19.91,95% CI = 8.64-31.18,Z = 3.46,p= 0.0005).3)The duration between the two-step surgery,the difference between ALPPS vs PVE group was statistically significant(MD=-30.48,95%CI=-37.87--23.09,Z=8.09,p<0.00001).4)R0resection rate was 68.8% in the ALPPS group and 60.8% in the PVE group.There was a significant difference between the two groups(OR =2.29,95% CI = 1.07-4.90,Z = 2.13,p = 0.03).5)There were no significant differences between ALPPS and PVE groups in the mortality rate of postoperative within 90-days,postoperative the total and major complication rates,postoperative liver failure,and total hospital stay.Conclusions:Based on the above comprehensive analysis,in comparison with PVE procedures,ALPPS has showed the faster FLR growth rate,a higher two-step operation rate,shorter two-step operation interval and more obvious R0 resection rate.ALPPS appears an effective treatment method for some liver cancer patients with insufficient FLR.However,the long-term benefits of ALPPS for the curative treatment of liver cancer remain unclear and depend on the large cohort observation on patients in the future.In addition,the majority patients of primary liver cancer are associated with liver cirrhosis in China with impacted regenerative capability of hepatocytes.Therefore,the application of either ALPPS or PVE were limited and depending on further investigation.