| Objective:A meta-analysis to explore the feasibility,safety,and effectiveness of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)compared with conventional two-stage hepatectomy(c TSH)for the treatment of liver malignancies with insufficient future liver remnant(FLR).Materials and methods:By searching Pub Med/Medline,Cochrane Library,Embase,Web of Science,CNKI,WANFANG DATA,CBM,VIP Chinese and English databases,according to the inclusion and exclusion criteria and literature quality assessment,select the clinical controlled studies of ALPPS vensus c TSH for the treatment of liver malignancies.Clinical comparison data of the two groups were extracted,including two-step operation completion rate,FLR growth rate,two-step operation interval time,R0 resection rate,90-day mortality,mobidity,postoperative liver failure rate,total hospital stay,1-year tumor-free survival rate etc.The meta-analysis was performed using the software of Revman5.3.Results:There were 14 clinical controlled studies included in total(13 cohort studies and 1 randomized controlled study),a total of 1015 patients,including 310 in ALPPS group and 705 in c TSH group.Baseline data such as age,sex,proportion of patients with cirrhosis,proportion of preoperative chemotherapy,and tumor type were comparable between the two groups.The meta-analysis results were as follows: Compared with c TSH,ALPPS had higher FLR growth rate(MD = 27.74,95% CI = 18.17-37.31,P <0.00001),shorter two-step surgical interval(MD =-31.60,95% CI =-39.16 ～-24.03,P <0.00001),higher completion rate of two-step surgery(OR = 8.60,95% CI = 4.84-15.28,P <0.00001),higher R0 resection rate(OR = 3.48,95% CI = 2.19-5.55,P <0.00001).The perioperative 90-day mortality,liver failure rate,total hospital stay,and long-term tumor prognosis were not significantly different between the two groups,but the postoperative morbidity was higher in ALPPS group(overall morbidity: OR = 1.82,95% CI = 1.06-3.15,P = 0.03 <0.05;major morbidity: OR = 1.83,95% CI = 1.28-2.62,P = 0.0009).In Year>2015 subgroup,the postoperative morbidity of ALPPS was not higher than that of c TSH(overall morbidity: OR = 1.29,95% CI = 0.63-2.66,P = 0.48;major morbidity: OR = 1.30,95% CI = 0.79-2.14,P = 0.30).In HCC subgroup,the FLR growth rate of ALPPS was not higher than that of c TSH(MD = 10.12,95% CI =-2.63 to 22.87,P = 0.12).Conclusion:1.Compared with c TSH,ALPPS has higher FLR growth rate,shorter two-step operation interval,higher two-step operation completion rate,higher R0 resection rate.The perioperative 90-day mortality,liver failure rate,total hospital stay,and long-term tumor prognosis were not significantly different between the two groups,but the postoperative morbidity of ALPPS was higher than that of c TSH in the early stage.2.In recent years,through strict patient selection,accumulation of surgical experience and improvement of surgical technique,the safety of ALPPS has been greatly improved,and the postoperative morbidity of ALPPS has been comparable to c TSH.ALPPS is a feasible,safe and effective surgical choice for patients of liver malignancies with insufficient FLR.3.For HCC patients with liver cirrhosis,the proliferation of FLR is limited,and the use of ALPPS should be cautious.Its application in metastatic liver malignancies without liver disease should be the main indication.However,ALPPS also has its application value in strict selected HCC patients with mild cirrhosis. |
