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Meta-analysis of associating liver partition with portal vein ligation and portal vein occlusion for two-stage hepatectomy.
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- Author(s): Eshmuminov, D.; Raptis, D. A.; Linecker, M.; Wirsching, A.; Lesurtel, M.; Clavien, P.‐A.
- Source:
British Journal of Surgery. Dec2016, Vol. 103 Issue 13, p1768-1782. 15p. - Source:
- Additional Information
- Subject Terms:
- Abstract: Background: Discussion is ongoing regarding whether associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) or portal vein occlusion is better in staged hepatectomy. The aim of this study was to compare available strategies using a two-stage approach in extended hepatectomy. Methods: A literature search was performed in MEDLINE, Scopus, the Cochrane Library and Embase, and additional articleswere identified by hand searching. Data from the international ALPPS registrywere extracted. Clinical studies reporting volumetric changes, mortality, morbidity, feasibility of the second stage and tumour-free resection margins (R0) in two-stage hepatectomy were included. Results: Ninety studies involving 4352 patients, including 320 from the ALPPS registry, met the inclusion criteria. Among these, nine studies (357 patients) reported on comparisons with other strategies. In the comparison of ALPPS versus portal vein embolization (PVE), ALPPS was associated with a greater increase in the future liver remnant (76 versus 37 per cent; P < 0·001) and more frequent completion of stage 2 (100 versus 77 per cent; P < 0·001). Compared with PVE, ALPPS had a trend towards higher morbidity (73 versus 59 per cent; P = 0·16) and mortality (14 versus 7 per cent; P = 0·19) after stage 2. In the non-comparative studies, complication rates were 39 per cent in the PVE group, 47 per cent in the portal vein ligation (PVL) group and 70 per cent in the ALPPS group. After stage 2, mortality rates were 5, 7 and 12 per cent respectively. Conclusion: ALPPS is associated with greater future liver remnant hypertrophy and a higher rate of completion of stage 2, but this may be at the price of greater morbidity and mortality. [ABSTRACT FROM AUTHOR]
- Abstract: Antecedentes: La controversia sobre si la asociación de la partición hepática y ligadura de la vena porta (associating liver partition and portal vein ligation for staged hepatectomy, ALPPS) o la oclusión venosa portal es mejor para la realización de una hepatectomía en dos fases continúa. El objetivo de este estudio fue comparar estas dos estrategias en la hepatectomía extendida en dos fases. Métodos: Se realizó una búsqueda bibliográfica en las bases de datos Medline, Scopus, Cochrane y Embase, añadiéndose artículos adicionales tras una búsqueda manual. Además, se obtuvieron los datos del registro internacional de ALPPS. Se incluyeron aquellos estudios en los que se realizó una hepatectomía en dos fases y proporcionaron información sobre los cambios volumétricos, la mortalidad, la morbilidad, la viabilidad de la segunda fase y los márgenes de resección libres de tumor (R0). Resultados: Cumplieron los criterios de inclusión 90 estudios con un total de 4.379 pacientes, incluyendo los 320 pacientes del registro ALPPS. Entre ellos, 9 estudios con 349 pacientes sirvieron para comparan otras estrategias. En la comparación entre ALPPS y embolización de la vena porta (portal vein embolization, PVE), la ALPPS proporcionó un incremento mayor del remanente hepático (76% versus 37%, P <0,001) y una mayor tasa de realización de la segunda fase de la hepatectomía (100% versus 77%, P <0,001). En comparación con PVE, ALPPS tuvo una mayor morbilidad (74% versus 59%, P =0,16) y mortalidad (14% versus 7%; P =0,21) después de la segunda fase. En los estudios no comparativos, las tasas de complicaciones fueron del 39% en el grupo de PVE, del 47% en el grupo con ligadura de la vena porta (portal vein ligation, PVL) y del 70% en el grupo de ALPPS. Después de la segunda fase, las tasas de mortalidad fueron del 5% en el grupo de PVE, 7% en el grupo LPV y del 12% en el grupo ALPPS. Conclusión: La ALPPS se asocia a una mayor hipertrofia del hígado remanente y una mayor tasa de realización de la segunda fase de la hepatectomía. Esto puede ser a costa de una mayor morbilidad y mortalidad en el grupo de ALPPS. [ABSTRACT FROM AUTHOR]
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