Greater hypertrophy can be achieved with associating liver partition with portal vein ligation for staged hepatectomy compared to conventional staged hepatectomy, but with a higher price to pay?

Chia, D.; Yeo, Zachery; Loh, Stanley; Iyer, Shridhar Ganpathi; Bonney, Glenn Kunnath; Madhavan, Krishnakumar; Kow, Alfred

doi:10.1016/j.amjsurg.2017.08.013

Cited by 18 publications

(12 citation statements)

References 22 publications

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“…Among the remaining 187 records, 175 citations were removed with various reasons. Finally, 11 full-text studies were suitable for this meta-analysis [9][10][11][12][13][14][15][16][17][18][19] (Fig.1). Besides the characteristics, quality evaluation, and demographics of the included studies are summarized in Table 1.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

“…Eleven literatures described the completion rate of two-step surgery in two groups, including a total of 867 patients [9][10][11][12][13][14][15][16][17][18][19]. There were 247 cases in ALPPS group and 620 cases in PVE group.…”

Section: The Second Stage Hepatectomymentioning

confidence: 99%

“…The R0 removal rate was described in ve literatures, involving a total of 307 patients [9,10,13,14,18]. There were 128 cases in ALPPS group and 179 cases in PVE group.…”

Section: The Rate Of R0 Resectionmentioning

confidence: 99%

“…All included literatures described the overall incidence of postoperative complications (including biliary stula, sepsis, abdominal infection, etc. ), including a total of 791 patients [9][10][11][12][13][14][15][16][17][18][19]. Among them, 240 cases in ALPPS group and 451 cases in PVE group showed no signi cant difference in the overall complication rate between the two groups (OR=1.14, 95%CI: 0.63~2.07, Z=0.44, P=0.66) ( Fig.…”

Section: Overall Postoperative Complication Ratementioning

confidence: 99%

“…The incidence of postoperative liver failure was described in 7 literatures, involving a total of 428 patients [11][12][13][14][15][16][17]. There were 119 cases in ALPPS group and 309 cases in PVE group, and there was no signi cant difference in the incidence of postoperative liver failure between the two groups (OR=0.83, 95%CI: 0.42~1.63, Z=0.54, P=0.59) (Fig.…”

Section: The Incidence Of Postoperative Liver Failurementioning

confidence: 99%

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The comparison of associating liver partition and portal vein ligation for staged hepatectomy versus portal vein embolization in postoperative outcomes and complications for the treatment of liver cancer with insufficient future liver remnant: a Meta analysis and systematic review

Zhou

Xia

Lei³

2020

Preprint

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Background: This study evaluated the feasibility, safety and effectiveness in patients treated with associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and portal vein embolization (PVE) for the treatment of liver malignant tumors with insufficient future liver remnant (FIR). Method: We performed a computer search on the PubMed databases to retrieve the RCT or clinical trials comparing ALPPS and PVE published from January 2010 to January 2020. The quality of the included trials was assessed according to the inclusion and exclusion criteria by two researchers independently. The RevMan 5.3 and STATA 12.0 software were used to extract and analyze the data. Result: A total of 11 retroprospective clinical trial articles comprising 867 patients were included in the study. The number of patients who underwent ALPPS were 247 and 620 for PVE. There were significant differences (P <0.05) in the second stage hepatectomy［OR=11.25, 95%CI: 5.64~22.43, Z=6.87, P＜0.001］, the sufficient FLR growth［MD=46.85, 95% CI:4~89.70, Z=2.41, P=0.03］, the time to stage II operation (MD=-22.85, 95% CI:-33.87~-11.84, Z=4.07, P＜0.001) and rate of R0 resection［OR=2.29, 95%CI: 1.07~4.90, Z=2.13, P=0.03］between the two groups. However, no significant differences were observed between ALPPS and PVE in terms of mortality within 90 days of perioperative period, overall postoperative complication rate, incidence of postoperative liver failure and postoperative hospital stay (P＞0. 05). Conclusion: Compared with PVE, The ALPPS procedure was associated with good postoperative outcomes with insufficient FLR. However, the clinical application of ALPPS and PVE has some limitations. Large, multicenter prospective randomized controlled trials are needed to validate these findings.

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Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Section: The Second Stage Hepatectomymentioning

confidence: 99%

“…The R0 removal rate was described in ve literatures, involving a total of 307 patients [9,10,13,14,18]. There were 128 cases in ALPPS group and 179 cases in PVE group.…”

Section: The Rate Of R0 Resectionmentioning

confidence: 99%

Section: Overall Postoperative Complication Ratementioning

confidence: 99%

Section: The Incidence Of Postoperative Liver Failurementioning

confidence: 99%

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The comparison of associating liver partition and portal vein ligation for staged hepatectomy versus portal vein embolization in postoperative outcomes and complications for the treatment of liver cancer with insufficient future liver remnant: a Meta analysis and systematic review

Zhou

Xia

Lei³

2020

Preprint

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Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: State of the art of parenchyma augmentation–assisted liver surgery

Müller¹,

Linecker

Kırımker

et al. 2021

Langenbecks Arch Surg

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Background Liver surgery and transplantation currently represent the only curative treatment options for primary and secondary hepatic malignancies. Despite the ability of the liver to regenerate after tissue loss, 25–30% future liver remnant is considered the minimum requirement to prevent serious risk for post-hepatectomy liver failure. Purpose The aim of this review is to depict the various interventions for liver parenchyma augmentation–assisting surgery enabling extended liver resections. The article summarizes one- and two-stage procedures with a focus on hypertrophy- and corresponding resection rates. Conclusions To induce liver parenchymal augmentation prior to hepatectomy, most techniques rely on portal vein occlusion, but more recently inclusion of parenchymal splitting, hepatic vein occlusion, and partial liver transplantation has extended the technical armamentarium. Safely accomplishing major and ultimately total hepatectomy by these techniques requires integration into a meaningful oncological concept. The advent of highly effective chemotherapeutic regimen in the neo-adjuvant, interstage, and adjuvant setting has underlined an aggressive surgical approach in the given setting to convert formerly “palliative” disease into a curative and sometimes in a “chronic” disease.

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ALPPS for Hepatocellular Carcinoma Is Associated with Decreased Liver Remnant Growth

Chia

Yeo

Loh

et al. 2018

Journal of Gastrointestinal Surgery

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Greater hypertrophy can be achieved with associating liver partition with portal vein ligation for staged hepatectomy compared to conventional staged hepatectomy, but with a higher price to pay?

Cited by 18 publications

References 22 publications

The comparison of associating liver partition and portal vein ligation for staged hepatectomy versus portal vein embolization in postoperative outcomes and complications for the treatment of liver cancer with insufficient future liver remnant: a Meta analysis and systematic review

The comparison of associating liver partition and portal vein ligation for staged hepatectomy versus portal vein embolization in postoperative outcomes and complications for the treatment of liver cancer with insufficient future liver remnant: a Meta analysis and systematic review

Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: State of the art of parenchyma augmentation–assisted liver surgery

ALPPS for Hepatocellular Carcinoma Is Associated with Decreased Liver Remnant Growth

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