1 research outputs found
Efficacy of Technical Modifications to the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Procedure
Objectives:. To compare the outcomes of modified-Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS) techniques with those of conventional-ALPPS.
Background:. ALPPS is an established technique for treating advanced liver tumors.
Methods:. PubMed, Web of Science, and Cochrane databases were searched. The outcomes were assessed by single-arm and 2-arm analyses.
Results:. Seventeen studies containing 335 modified-ALPPS patients were included in single-arm meta-analysis. The estimated blood loss was 267βΒ±β29βmL (95% confidence interval [CI], 210β324βmL) during the first and 662βΒ±β51βmL (95% CI, 562β762βmL) during the second stage. The operation time was 166βΒ±β18 minutes (95% CI, 131β202 minutes) during the first and 225βΒ±β19 minutes (95% CI, 188β263 minutes) during the second stage. The major morbidity rate was 14% (95% CI, 9%β22%) after the first stage. The future liver remnant hypertrophy rate was 65.2% Β± 5% (95% CI, 55%β75%) and the interstage interval was 16βΒ±β1 days (95% CI, 14β17 days). The dropout rate was 9% (95% CI, 5%β15%). The overall complication rate was 46% (95% CI, 37%β56%) and the major complication rate was 20% (95% CI, 14%β26%). The postoperative mortality rate was 7% (95% CI, 4%β11%). Seven studies containing 215 patients were included in comparative analysis. The hypertrophy rate was not different between 2 methods (mean difference [MD], β5.01; 95% CI, β19.16 to 9.14; P = 0.49). The interstage interval was shorter for partial-ALPPS (MD, 9.43; 95% CI, 3.29β15.58; P = 0.003). The overall complication rate (odds ratio [OR], 10.10; 95% CI, 2.11β48.35; P = 0.004) and mortality rate (OR, 3.74; 95% CI, 1.36β10.26; P = 0.01) were higher in the conventional-ALPPS.
Conclusions:. The hypertrophy rate in partial-ALPPS was similar to conventional-ALPPS. This shows that minimizing the first stage of the operation does not affect hypertrophy. Moreover, the postoperative overall morbidity and mortality rates were lower following partial-ALPPS