Bozkurt Emre, Sijberden Jasper P, Kasai Meidai, Abu Hilal Mohammad
Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Department of Surgery, Hepatopancreatobiliary Surgery Division, Koç University Hospital, Istanbul, Turkey.
Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
HPB (Oxford). 2024 Apr;26(4):465-475. doi: 10.1016/j.hpb.2024.01.002. Epub 2024 Jan 4.
In daily clinical practice, different future liver remnant (FLR) modulation techniques are increasingly used to allow a liver resection in patients with insufficient FLR volume. This systematic review and network meta-analysis aims to compare the efficacy and perioperative safety of portal vein ligation (PVL), portal vein embolization (PVE), liver venous deprivation (LVD) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).
A literature search for studies comparing liver resections following different FLR modulation techniques was performed in MEDLINE, Embase and Cochrane Central, and pairwise and network meta-analyses were conducted.
Overall, 23 studies comprising 1557 patients were included. LVD achieved the greatest increase in FLR (17.32 %, 95% CI 2.49-32.15), while ALPPS was most effective in preventing dropout before the completion hepatectomy (OR 0.29, 95% CI 0.15-0.55). PVL tended to be associated with a longer time to completion hepatectomy (MD 5.78 days, 95% CI -0.67-12.23). Liver failure occurred less frequently after LVD, compared to PVE (OR 0.35, 95% CI 0.14-0.87) and ALPPS (OR 0.28, 95% CI 0.09-0.85).
ALPPS and LVD seem superior to PVE and PVL in terms of achieved FLR increase and subsequent treatment completion. LVD was associated with lower rates of post hepatectomy liver failure, compared to both PVE and ALPPS. A summary of the protocol has been prospectively registered in the PROSPERO database (CRD42022321474).
在日常临床实践中，越来越多地使用不同的未来肝残余量（FLR）调节技术，以使FLR体积不足的患者能够进行肝切除术。本系统评价和网状Meta分析旨在比较门静脉结扎术（PVL）、门静脉栓塞术（PVE）、肝静脉离断术（LVD）以及联合肝脏分隔和门静脉结扎分期肝切除术（ALPPS）的疗效和围手术期安全性。
在MEDLINE、Embase和Cochrane Central中检索比较不同FLR调节技术后肝切除术的研究，并进行成对和网状Meta分析。
总体而言，纳入了23项研究，共1557例患者。LVD使FLR增加最多（17.32%，95%CI 2.49-32.15），而ALPPS在防止肝切除完成前退出方面最有效（OR 0.29，95%CI 0.15-0.55）。PVL往往与完成肝切除术的时间较长有关（MD 5.78天，95%CI -0.67-12.23）。与PVE（OR 0.35，95%CI 0.14-0.87）和ALPPS（OR 0.28，95%CI 0.09-0.85）相比，LVD后肝衰竭的发生率较低。
在实现FLR增加和后续治疗完成方面，ALPPS和LVD似乎优于PVE和PVL。与PVE和ALPPS相比，LVD与肝切除术后肝衰竭的发生率较低有关。该方案的摘要已在PROSPERO数据库（CRD42022321474）中进行了前瞻性注册。
