Background

There is an ongoing debate on the feasibility, safety, and oncological efficacy of the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique. The aim of this study was to compare ALPPS, two-staged hepatectomy (TSH), and portal vein embolization (PVE)/ligation (PVL) using updated traditional meta-analysis and network meta-analysis (NMA).

Data sources

Electronic databases were used in a systematic literature search. Updated traditional meta-analysis and NMA were performed and compared. Mortality and major morbidity were selected as primary outcomes.

Results

Nineteen studies including 1200 patients were selected from the pool of 436 studies. Of these patients, 315 (31%) and 702 (69%) underwent ALPPS and portal vein occlusion (PVO), respectively. Ninety-day mortality based on updated traditional meta-analysis, subgroup analysis of the randomized controlled trials (RCTs), and both Bayesian and frequentist NMA did not demonstrate significant differences between the ALPPS cohort and the PVE, PVL, and TSH cohorts. Moreover, analysis of RCTs did not demonstrate significant differences of major morbidity between the ALPPS and PVO cohorts. The ALPPS cohort demonstrated significantly more favorable outcomes in hypertrophy parameters, time to operation, definitive hepatectomy, and R0 margins rates compared with the PVO cohort. In contrast, 1-year disease-free survival was significantly higher in the PVO cohort compared to the ALPPS cohort.

Conclusions

This study is the first to use updated traditional meta-analysis and both Bayesian and frequentist NMA and demonstrated no significant differences in 90-day mortality between the ALPPS and other hepatic hypertrophy approaches. Furthermore, two high quality RCTs including 147 patients demonstrated no significant differences in major morbidity between the ALPPS and PVO cohorts.

中文翻译：

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ALPPS、两阶段肝切除术和门静脉栓塞/结扎术的死亡率没有差异：通过更新的传统和网络荟萃分析进行的系统评价。

背景

关于分阶段肝切除术 (ALPPS) 联合肝脏分隔和门静脉结扎术的可行性、安全性和肿瘤学疗效存在持续的争论。本研究的目的是使用更新的传统荟萃分析和网络荟萃分析 (NMA) 比较 ALPPS、两阶段肝切除术 (TSH) 和门静脉栓塞术 (PVE)/结扎术 (PVL)。

数据源

电子数据库被用于系统的文献检索。更新了传统的荟萃分析和 NMA 进行了比较。死亡率和主要发病率被选为主要结果。

结果

从 436 项研究中选出 19 项研究，包括 1200 名患者。在这些患者中，315 (31%) 和 702 (69%) 分别接受了 ALPPS 和门静脉阻塞 (PVO)。基于更新的传统荟萃分析、随机对照试验 (RCT) 的亚组分析以及贝叶斯和频率论 NMA 的 90 天死亡率并未证明 ALPPS 队列与 PVE、PVL 和 TSH 队列之间存在显着差异。此外，随机对照试验的分析并未表明 ALPPS 和 PVO 队列之间的主要发病率存在显着差异。与 PVO 队列相比，ALPPS 队列在肥大参数、手术时间、确定性肝切除术和 R0 边缘率方面表现出明显更有利的结果。相比之下，

结论

本研究首次使用更新的传统荟萃分析以及贝叶斯和频率论 NMA，并证明 ALPPS 和其他肝肥大方法之间的 90 天死亡率没有显着差异。此外，包括 147 名患者在内的两项高质量 RCT 表明，ALPPS 和 PVO 队列之间的主要发病率没有显着差异。