Systematic Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2019; 25(39): 6016-6024
Published online Oct 21, 2019. doi: 10.3748/wjg.v25.i39.6016
Complete or partial split in associating liver partition and portal vein ligation for staged hepatectomy: A systematic review and meta-analysis
Han-Chun Huang, Jin Bian, Yi Bai, Xin Lu, Yi-Yao Xu, Xin-Ting Sang, Hai-Tao Zhao
Han-Chun Huang, Jin Bian, Yi Bai, Xin Lu, Yi-Yao Xu, Xin-Ting Sang, Hai-Tao Zhao, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: Huang HC analyzed data, wrote the paper; Bian J performed research; Bai Y contributed analytic tools; Lu X performed research; Xu YY performed research; Sang XT performed research; Zhao HT designed research.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hai-Tao Zhao, MD, Professor, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Wangfujing, Beijing 100730, China. zhaoht@pumch.cn
Telephone: +86-10-69156042 Fax: +86-10-69156043
Received: August 24, 2019
Peer-review started: August 24, 2019
First decision: September 10, 2019
Revised: September 17, 2019
Accepted: September 27, 2019
Article in press: September 27, 2019
Published online: October 21, 2019
Processing time: 58 Days and 9.1 Hours
Abstract
BACKGROUND

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been adopted by liver surgeons in recent years. However, high morbidity and mortality rates have limited the promotion of this technique. Some recent studies have suggested that ALPPS with a partial split can effectively induce the growth of future liver remnant (FLR) similar to a complete split with better postoperative safety profiles. However, some others have suggested that ALPPS can induce more rapid and adequate FLR growth, but with the same postoperative morbidity and mortality rates as in partial split of the liver parenchyma in ALPPS (p-ALPPS).

AIM

To perform a systematic review and meta-analysis on ALPPS and p-ALPPS.

METHODS

A systematic literature search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov was performed for articles published until June 2019. Studies comparing the outcomes of p-ALPPS and ALPPS for a small FLR in consecutive patients were included. Our main endpoints were the morbidity, mortality, and FLR hypertrophy rates. We performed a subgroup analysis to evaluate patients with and without liver cirrhosis. We assessed pooled data using a random-effects model.

RESULTS

Four studies met the inclusion criteria. Four studies reported data on morbidity and mortality, and two studies reported the FLR hypertrophy rate and one study involved patients with cirrhosis. In the non-cirrhotic group, p-ALPPS-treated patients had significantly lower morbidity and mortality rates than ALPPS-treated patients [odds ratio (OR) = 0.2; 95% confidence interval (CI): 0.07–0.57; P = 0.003 and OR = 0.16; 95%CI: 0.03-0.9; P = 0.04]. No significant difference in the FLR hypertrophy rate was observed between the two groups (P > 0.05). The total effects indicated no difference in the FLR hypertrophy rate or perioperative morbidity and mortality rates between the ALPPS and p-ALPPS groups. In contrast, ALPPS seemed to have a better outcome in the cirrhotic group.

CONCLUSION

The findings of our study suggest that p-ALPPS is safer than ALPPS in patients without cirrhosis and exhibits the same rate of FLR hypertrophy.

Keywords: Liver, Cancer; Partial split; Staged hepatectomy; Systematic review; Meta-analysis

Core tip: Several studies have reported the comparison of complete and partial associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). This meta-analysis, including all of these studies published to date, found that the partial ALPPS is safer than ALPPS in patients without cirrhosis and exhibits the same rate of future liver remnant hypertrophy. However, as the sample size is not large, more randomized controlled trials should be carried out.