Image_14_Conventional Two-Stage Hepatectomy or Associating Liver Partitioning and Portal Vein Ligation for Staged Hepatectomy for Colorectal Liver Metastases? A Systematic Review and Meta-Analysis.TIF
Background: Pushing the surgical limits for initially unresectable colorectal liver metastases (CRLM) are two approaches for sequential liver resection: two-stage hepatectomy (TSH) and associating liver partitioning and portal vein ligation for staged hepatectomy (ALPPS). However, the role of each treatment modality remains ill-defined. The present meta-analysis was designed to compare the safety, efficacy, and oncological benefits between ALPPS and TSH in the management of advanced CRLM.
Methods: A systematic literature search was conducted from online databases through to February 2020. Single-arm synthesis and cumulative meta-analysis were performed.
Results: Eight studies were included, providing a total of 409 subjects for analysis (ALPPS: N = 161; TSH: N = 248). The completions of the second stage of the hepatectomy [98 vs. 78%, odds ratio (OR) 5.75, p < 0.001] and R0 resection (66 vs. 37%; OR 4.68; p < 0.001) were more frequent in patients receiving ALPPS than in those receiving TSH, and the waiting interval was dramatically shortened in ALPPS (11.6 vs. 45.7 days, weighted mean difference = −35.3 days, p < 0.001). Nevertheless, the rate of minor complications was significantly higher in ALPPS (59 vs. 18%, OR 6.5, p < 0.001) than in TSH. The two treatments were similar in 90-day mortality (7 vs. 5%, p = 0.43), major complications (29 vs. 22%, p = 0.08), posthepatectomy liver failure (PHLF; 9 vs. 9%, p = 0.3), biliary leakage (11 vs. 14%, p = 0.86), length of hospital stay (27.95 vs. 26.88 days, p = 0.8), 1-year overall survival (79 vs. 84%, p = 0.61), 1-year recurrence (49 vs. 39%, p = 0.32), and 1-year disease-free survival (34 vs. 39%, p = 0.66). Cumulative meta-analyses indicated chronological stability for the pooled effect sizes of resection rate, 90-day mortality, major complications, and PHLF.
Conclusions: Compared with TSH, ALPPS for advanced CRLM resulted in superior surgical efficacy with comparable perioperative mortality rate and short-term oncological outcomes, while this was at the cost of increased perioperative minor complications.
History
References
- https://doi.org//10.3389/fonc.2019.01052
- https://doi.org//10.1002/ags3.12276
- https://doi.org//10.1159/000449495
- https://doi.org//10.1016/j.ejso.2011.12.009
- https://doi.org//10.1097/SLA.0b013e3181907fd9
- https://doi.org//10.1200/JCO.2010.32.6132
- https://doi.org//10.1002/bjs.7580
- https://doi.org//10.1097/SLA.0b013e31824856f5
- https://doi.org//10.1055/s-0033-1356364
- https://doi.org//10.1016/j.hpb.2017.08.013
- https://doi.org//10.1016/j.ejso.2013.08.009
- https://doi.org//10.1007/s00268-019-05031-w
- https://doi.org//10.1002/bjs.10256
- https://doi.org//10.1016/j.hpb.2016.01.439
- https://doi.org//10.1007/s00268-017-4181-6
- https://doi.org//10.1016/j.jamcollsurg.2013.03.004
- https://doi.org//10.1007/s00268-014-2513-3
- https://doi.org//10.1097/SLA.0000000000002511
- https://doi.org//10.1371/journal.pmed.1000097
- https://doi.org//10.1007/s10654-010-9491-z
- https://doi.org//10.1097/SLA.0000000000002731
- https://doi.org//10.1016/j.jclinepi.2020.04.006
- https://doi.org//10.1245/s10434-016-5419-5
- https://doi.org//10.1007/s11605-017-3523-x
- https://doi.org//10.1007/s11605-019-04145-9
- https://doi.org//10.1016/j.hpb.2018.06.008
- https://doi.org//10.1097/01.sla.0000145965.86383.89
- https://doi.org//10.1002/bjs.10290
- https://doi.org//10.1007/s13304-013-0243-y
- https://doi.org//10.1016/j.hpb.2019.08.011
- https://doi.org//10.1097/SLA.0000000000002446
- https://doi.org//10.1097/SLA.0000000000000947
- https://doi.org//10.1016/j.hbpd.2019.04.006
- https://doi.org//10.3760/cma.j.issn.0529-5815.2019.07.012
- https://doi.org//10.1097/MD.0000000000015229
- https://doi.org//10.1016/j.surg.2014.12.009
- https://doi.org//10.1097/MD.0000000000012082
- https://doi.org//10.1016/j.hpb.2018.06.1798
- https://doi.org//10.23736/S0026-4806.17.05096-0
- https://doi.org//10.1186/s12957-017-1295-0
- https://doi.org//10.1016/j.ejso.2015.01.004
- https://doi.org//10.1245/s10434-006-9023-y
- https://doi.org//10.1016/j.hpb.2020.04.009
- https://doi.org//10.1097/SLA.0000000000001450
- https://doi.org//10.1016/j.surg.2014.08.041
- https://doi.org//10.1016/j.surg.2015.11.013
- https://doi.org//10.1016/j.hpb.2018.11.010
- https://doi.org//10.21037/hbsn.2018.12.02
- https://doi.org//10.1016/j.jamcollsurg.2015.12.057
- https://doi.org//10.1097/SLA.0000000000000949
- https://doi.org//10.1159/000488097
- https://doi.org//10.3389/fonc.2019.01206
- https://doi.org//10.1016/j.surg.2017.05.022
- https://doi.org//10.1002/bjs.7456
- https://doi.org//10.1245/s10434-017-5922-3
- https://doi.org//10.1016/j.surg.2015.12.004
- https://doi.org//10.1007/s00268-013-2401-2
- https://doi.org//10.1016/j.surg.2017.10.036
- https://doi.org//10.1001/jamasurg.2013.2126
- https://doi.org//10.1097/SLA.0000000000003701
- https://doi.org//10.1097/SLA.0000000000002797
- https://doi.org//10.1097/SLA.0000000000003433
- https://doi.org//10.1097/SLA.0000000000002942
- https://doi.org//10.1016/j.jclinepi.2009.04.005
CC BY 4.0