Gavriilidis Paschalis, Sutcliffe Robert P, Roberts Keith J, Pai Madhava, Spalding Duncan, Habib Nagy, Jiao Long R, Sodergren Mikael H
Department of Hepatopanceaticobiliary Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK.
Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK.
Hepatobiliary Pancreat Dis Int. 2020 Oct;19(5):411-419. doi: 10.1016/j.hbpd.2020.07.005. Epub 2020 Jul 25.
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).
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.
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.
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.
关于联合肝脏分隔和门静脉结扎分期肝切除术（ALPPS）技术的可行性、安全性及肿瘤学疗效，目前仍存在争议。本研究旨在采用更新的传统荟萃分析和网状荟萃分析（NMA）比较ALPPS、两阶段肝切除术（TSH）以及门静脉栓塞术（PVE）/门静脉结扎术（PVL）。
通过系统文献检索使用电子数据库。进行并比较更新的传统荟萃分析和NMA。将死亡率和严重并发症选为主要结局指标。
从436项研究中筛选出19项研究，共1200例患者。其中，分别有315例（31%）和702例（69%）患者接受了ALPPS和门静脉闭塞术（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学派NMA的90天死亡率，在ALPPS队列与PVE、PVL和TSH队列之间未显示出显著差异。此外，RCT分析未显示ALPPS和PVO队列之间严重并发症有显著差异。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切缘率方面显示出更有利的结果。相比之下，PVO队列的1年无病生存率显著高于ALPPS队列。
本研究首次使用更新的传统荟萃分析以及贝叶斯和频率学派NMA，结果显示ALPPS与其他肝脏肥大方法在90天死亡率方面无显著差异。此外，两项纳入147例患者的高质量RCT显示，ALPPS和PVO队列之间在严重并发症方面无显著差异。
