Abstract
BackgroundIt is generally accepted that an insufficient future liver remnant is a major limitation of large-scale hepatectomy for patients with primary hepatocellular carcinoma. Conventional two-stage hepatectomy (TSH) is commonly considered to accelerate future liver regeneration despite its low regeneration rate. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), which is characterized by a rapid regeneration, has brought new opportunities.MethodsRelevant studies were identified by searching the selected databases up to September 2017. Then, a meta-analysis of regeneration efficiency, complication rate, R0 resection ratio, and short-term outcomes was performed.ResultsTen studies, comprising 719 patients, were included. The overall analysis showed that ALPPS was associated with a larger hyperplastic volume and a shorter time interval (P < 0.00001) than TSH. ALPPS also exhibited a higher completion rate for second-stage operations (odds ratio, OR 9.50; P < 0.0001) and a slightly higher rate of R0 resection (OR 1.90; P = 0.11). Interestingly, there was no significant difference in 90-day mortality between the two treatments (OR 1.44; P = 0.35).ConclusionsThese results indicate that compared with TSH, ALPPS possesses a stronger regenerative ability and better facilitates second-stage operations. However, the safety, patient outcomes, and patient selection for ALPPS require further study.
Highlights
It is generally accepted that an insufficient future liver remnant is a major limitation of large-scale hepatectomy for patients with primary hepatocellular carcinoma
These results indicate that compared with two-stage hepatectomy (TSH), ALPPS possesses a stronger regenerative ability and better facilitates second-stage operations
A very common reason is the limited future liver remnant (FLR), one of the determining factors leading to postoperative liver failure (PLF), which restricts the application of this method
Summary
It is generally accepted that an insufficient future liver remnant is a major limitation of large-scale hepatectomy for patients with primary hepatocellular carcinoma. Conventional two-stage hepatectomy (TSH) is commonly considered to accelerate future liver regeneration despite its low regeneration rate. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), which is characterized by a rapid regeneration, has brought new opportunities. A very common reason is the limited future liver remnant (FLR), one of the determining factors leading to postoperative liver failure (PLF), which restricts the application of this method. In 2012, a new surgical approach named “associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)”, characterized by great liver regeneration efficiency, was proposed by Schnitzbauer et al [5]. Standard methods for patient selection and the long-term outcomes of this new approach remain controversial
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