Two stage hepatectomy (TSH) versus ALPPS for initially unresectable colorectal liver metastases: A systematic review and meta-analysis |
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| Institution: | 1. Department of HPB Surgery and Transplantation Unit, Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain;2. Health Research Institute of the Principality of Asturias (ISPA), Spain;3. Department of Surgery, University of Oviedo, Spain;4. Department of Anaesthesiology, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain;5. Department of General Surgery, Hospital Universitario San Agustín (HUSA), Avilés, Spain;6. Department of Medical Oncology, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain;7. Department of HPB Surgery and Transplantation Unit, Division of General Surgery, Hospital La Fe, Valencia, Spain;8. Department of Colorectal Surgery, Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain;1. Colorectal and General Surgery Unit, Ospedale per gli Infermi Faenza and Ospedale Santa Maria delle Croci Ravenna, AUSL Romagna, Italy;2. University of Bologna, Italy;3. Department of Medical Oncology, Ospedale per gli Infermi, Faenza, AUSL Romagna, Italy;1. Medical Oncology, Hospital Universitario de Torrejon, Spain;2. Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain;3. General Surgery, Hospital Universitario de Torrejón, Spain;4. Radiation Oncology, Hospital Universitario de Torrejón, Spain;1. Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;2. Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;3. Department of Hepatobiliary and Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan;1. Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy;2. Division of Hepatobiliary Surgery, Regina Elena Cancer Institute, Rome, Lazio, Italy;3. Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy;4. Division of Radiology, National Institute for Infectious Diseases “L. Spallanzani”, Rome, Italy;5. Intensive Care Unit, National Institute for Infectious Diseases “L. Spallanzani”, Rome, Italy;6. Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani”, Rome, Italy |
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| Abstract: | BackgroundAlthough 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).MethodsMain 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.ResultsA 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.ConclusionALPPS 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. |
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| Keywords: | Unresectable colorectal liver metastases TSH ALPPS Portal vein ligation Portal vein embolization Future liver remnant |
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