Abstract
Background
Although numerous comparisons between conventional Two Stage Hepatectomy (TSH) and
Associating Liver Partition and Portal Vein Ligation for staged hepatectomy (ALPPS)
have been reported, the heterogeneity of malignancies previously compared represents
an important source of selection bias. This systematic review and meta-analysis aimed
to compare perioperative and oncological outcomes between TSH and ALPPS to treat patients
with initially unresectable colorectal liver metastases (CRLM).
Methods
Main electronic databases were searched using medical subject headings for CRLM surgically
treated with TSH or ALPPS. Patients treated for primary or secondary liver malignancies
other than CRLM were excluded.
Results
A total of 335 patients from 5 studies were included. Postoperative major complications
were higher in the ALPPS group (relative risk [RR] 1.46, 95% confidence interval [CI]
1.04–2.06, I2 = 0%), while no differences were observed in terms of perioperative mortality (RR
1.53, 95% CI 0.64–3.62, I2 = 0%). ALPPS was associated with higher completion of hepatectomy rates (RR 1.32,
95% CI 1.09–1.61, I2 = 85%), as well as R0 resection rates (RR 1.61, 95% CI 1.13–2.30, I2 = 40%). Nevertheless, no significant differences were achieved between groups in
terms of overall survival (OS) (RR 0.93, 95% CI 0.68–1.27, I2 = 52%) and disease-free survival (DFS) (RR 1.08, 95% CI 0.47–2.49, I2 = 54%), respectively.
Conclusion
ALPPS and TSH to treat CRLM seem to have comparable operative risks in terms of mortality
rates. No definitive conclusions regarding OS and DFS can be drawn from the results.
Keywords
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Article info
Publication history
Published online: November 08, 2022
Accepted:
November 3,
2022
Received in revised form:
October 3,
2022
Received:
April 28,
2022
Identification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
