Original Article
Comparison of portal vein embolization, portal vein ligation, associating liver partition and portal vein ligation for staged hepatectomy in cases with a small future liver remnant: a network meta-analysis
Abstract
Background: The optimal surgery for liver cancer cases with small future liver remnant (FLR) remains controversial; associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), portal vein embolization (PVE), and portal vein ligation (PVL) are all used.
Methods: We conducted a systematic search in the EMBASE, Medline and Cochrane databases, without year or language restrictions, to identify studies that compared PVE, PVL, and ALPPS. We compared the feasibility, safety, and efficacy of PVE, PVL, and ALPPS using network meta-analyses. this study do not involve ethical issues.
Results: Ten studies and 451 patients were included. PVE had a significantly reduced FLR increase (42.2%; 95% CI, 26.52–57.87; P<0.001) and resection completion rate (89.2%; OR =0.108; 95% CI, 0.02–0.585; P=0.01) compared with ALPPS. PVE also had a non-significant reduction in morbidity and mortality, and a non-significant increase in waiting time from first intervention to removal of tumors than ALPPS. Similarly, PVL had a significantly reduced FLR increase (47.65%; 95% CI, 29.43–65.88%; P<0.001) and resection completion rate (91.6%; OR =0.084; 95% CI, 0.013–0.532; P=0.009) compared with ALPPS; as well as a non-significant reduction in morbidity and mortality, and increase in waiting time versus ALPPS. Rank analysis indicated that ALPPS was superior, with respective probabilities of 100%, 99.4%, and 44.9% for FLR increase, resection completion, and waiting time; PVE and PVL were not significantly different.
Conclusions: ALPPS was significantly more efficient than PVE and PVL regarding promotion of FLR hypertrophy, resection completion, and waiting time. The three techniques were similar regarding morbidity and mortality.
Methods: We conducted a systematic search in the EMBASE, Medline and Cochrane databases, without year or language restrictions, to identify studies that compared PVE, PVL, and ALPPS. We compared the feasibility, safety, and efficacy of PVE, PVL, and ALPPS using network meta-analyses. this study do not involve ethical issues.
Results: Ten studies and 451 patients were included. PVE had a significantly reduced FLR increase (42.2%; 95% CI, 26.52–57.87; P<0.001) and resection completion rate (89.2%; OR =0.108; 95% CI, 0.02–0.585; P=0.01) compared with ALPPS. PVE also had a non-significant reduction in morbidity and mortality, and a non-significant increase in waiting time from first intervention to removal of tumors than ALPPS. Similarly, PVL had a significantly reduced FLR increase (47.65%; 95% CI, 29.43–65.88%; P<0.001) and resection completion rate (91.6%; OR =0.084; 95% CI, 0.013–0.532; P=0.009) compared with ALPPS; as well as a non-significant reduction in morbidity and mortality, and increase in waiting time versus ALPPS. Rank analysis indicated that ALPPS was superior, with respective probabilities of 100%, 99.4%, and 44.9% for FLR increase, resection completion, and waiting time; PVE and PVL were not significantly different.
Conclusions: ALPPS was significantly more efficient than PVE and PVL regarding promotion of FLR hypertrophy, resection completion, and waiting time. The three techniques were similar regarding morbidity and mortality.
