Operative Results and Oncologic Outcomes of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Versus Two-Stage Hepatectomy (TSH) in Patients with Unresectable Colorectal Liver Metastases: A Systematic Review and Meta-Analysis

• Published in: World journal of surgery Vol. 42; no. 3; pp. 806 - 815
• Main Authors: Moris, Dimitrios, Ronnekleiv-Kelly, Sean, Kostakis, Ioannis D., Tsilimigras, Diamantis I., Beal, Eliza W., Papalampros, Alexandros, Dimitroulis, Dimitrios, Felekouras, Evangelos, Pawlik, Timothy M.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2018; John Wiley & Sons, Inc
• Subjects: Abdominal Surgery; Adenocarcinoma - mortality; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Cardiac Surgery; Clinical trials; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; General Surgery; Growth rate; Hepatectomy; Hepatectomy - methods; Humans; Ligation; Liver; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Materials selection; Medicine; Medicine & Public Health; Meta-analysis; Metastases; Metastasis; Morbidity; Partitions; Patients; Portal vein; Portal Vein - surgery; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Scientific Review; Studies; Surgery; Systematic review; Thoracic Surgery; Treatment Outcome; Vascular Surgery
• ISSN: 0364-2313; 1432-2323; 1432-2323
• DOI: 10.1007/s00268-017-4181-6

Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently emerged as a treatment choice for patients with colorectal liver metastases (CLM) and inadequate future liver remnant (FLR). The aim of this study was to define the results of ALPPS compared with two-stage hepatectomy (TSH) for patients with CLM. Materials and methods A meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Identification of eligible studies was performed using three distinct databases through February 2017; Medline, ClinicalTrials.gov and Cochrane library—Cochrane Central Register of Controlled Trials using a syntax including medical subject headings terms “portal vein ligation,” “PVE,” “staged hepatectomy,” “staged liver resection,” “liver resection,” “two-stage hepatectomy,” “TSH,” “in situ liver transection with portal vein ligation,” “associating liver partition and portal vein ligation for staged hepatectomy” and “ALPPS”. Results Among the 634 records identified, 9 studies comparing ALPPS with TSH met the inclusion criteria. These studies included 657 patients with unresectable CLM (ALPPS, n  = 186 vs TSH, n  = 471). There was no difference in final postoperative FLR between ALPPS versus TSH (mean difference: 31.72, 95% CI: −27.33 to 90.77, p  = 0.29). The kinetic growth rate was faster with the ALPPS versus TSH (mean difference 19.07 ml/day, 95% CI 8.12–30.02, p  = 0.0006). TSH had a lower overall and major morbidity versus ALPPS (overall morbidity: RR: 1.39, 95% CI: 1.07–1.8, p  = 0.01; I 2 : 58%, p  = 0.01; major morbidity: RR: 1.57, 95% CI: 1.18–2.08, p  = 0.002; I 2 : 0%, p  = 0.44). Overall survival was comparable following ALPPS versus TSH. Conclusion While ALPPS may be a suitable approach for patients, the higher morbidity and mortality should be considered when determining the operative approach for patients with extensive CLM.