Efficacy and Safety of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Versus Two-Stage Hepatectomy: a Systematic Review and Meta-analysis

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been widely used in recent years. However, the clinical outcomes of ALPPS compared with that of two-stage hepatectomy (TSH) remain controversial. This meta-analysis aimed to compare the safety and efficacy of ALPPS and TSH. Relevant studies were retrieved via a search of the “MEDLINE,” “EMBASE,” and “SCIENCE DIRECT” databases. A meta-analysis of the mortality rate, second surgery completion rate, and future remnant liver regeneration rate was performed using the fixed-effects and random-effects models. A total of five studies were assessed that included 332 patients in the TSH group and 103 in the ALPPS group. The overall mortality rate in the ALPPS group (61.4%) was significantly higher as compared with that in the TSH group (39.1%) (χ2 = 11.23; Z = 4.77; P < 0.0001). The second surgery completion rate in the ALPPS group (92.2%) was significantly higher as compared with that in the TSH group (75.9%) (χ2 = 2.33; Z = 3.53; P = 0.0004). The average future remnant liver regeneration rate in the ALPPS group (69.5%) was significantly greater as compared with that in the TSH group (48.3%) (χ2 = 51.05; Z = 10.56; P < 0.0001). ALPPS can promote future liver regeneration, while TSH is associated with a lower mortality rate. The safety of ALPPS needs to be improved in further studies.