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Operative Results and Oncologic Outcomes of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Versus Two-Stage Hepatectomy (TSH) in Patients with Unresectable Colorectal Liver Metastases: A Systematic Review and Meta-Analysis.

Publication ,  Journal Article
Moris, D; Ronnekleiv-Kelly, S; Kostakis, ID; Tsilimigras, DI; Beal, EW; Papalampros, A; Dimitroulis, D; Felekouras, E; Pawlik, TM
Published in: World journal of surgery
March 2018

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently emerged as a treatment choice for patients with colorectal liver metastases (CLM) and inadequate future liver remnant (FLR). The aim of this study was to define the results of ALPPS compared with two-stage hepatectomy (TSH) for patients with CLM.A meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Identification of eligible studies was performed using three distinct databases through February 2017; Medline, ClinicalTrials.gov and Cochrane library-Cochrane Central Register of Controlled Trials using a syntax including medical subject headings terms "portal vein ligation," "PVE," "staged hepatectomy," "staged liver resection," "liver resection," "two-stage hepatectomy," "TSH," "in situ liver transection with portal vein ligation," "associating liver partition and portal vein ligation for staged hepatectomy" and "ALPPS".Among the 634 records identified, 9 studies comparing ALPPS with TSH met the inclusion criteria. These studies included 657 patients with unresectable CLM (ALPPS, n = 186 vs TSH, n = 471). There was no difference in final postoperative FLR between ALPPS versus TSH (mean difference: 31.72, 95% CI: -27.33 to 90.77, p = 0.29). The kinetic growth rate was faster with the ALPPS versus TSH (mean difference 19.07 ml/day, 95% CI 8.12-30.02, p = 0.0006). TSH had a lower overall and major morbidity versus ALPPS (overall morbidity: RR: 1.39, 95% CI: 1.07-1.8, p = 0.01; I 2: 58%, p = 0.01; major morbidity: RR: 1.57, 95% CI: 1.18-2.08, p = 0.002; I 2: 0%, p = 0.44). Overall survival was comparable following ALPPS versus TSH.While ALPPS may be a suitable approach for patients, the higher morbidity and mortality should be considered when determining the operative approach for patients with extensive CLM.

Duke Scholars

Published In

World journal of surgery

DOI

EISSN

1432-2323

ISSN

0364-2313

Publication Date

March 2018

Volume

42

Issue

3

Start / End Page

806 / 815

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Postoperative Complications
  • Portal Vein
  • Liver Neoplasms
  • Ligation
  • Humans
  • Hepatectomy
  • Colorectal Neoplasms
  • Adenocarcinoma
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Moris, D., Ronnekleiv-Kelly, S., Kostakis, I. D., Tsilimigras, D. I., Beal, E. W., Papalampros, A., … Pawlik, T. M. (2018). Operative Results and Oncologic Outcomes of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Versus Two-Stage Hepatectomy (TSH) in Patients with Unresectable Colorectal Liver Metastases: A Systematic Review and Meta-Analysis. World Journal of Surgery, 42(3), 806–815. https://doi.org/10.1007/s00268-017-4181-6
Moris, Dimitrios, Sean Ronnekleiv-Kelly, Ioannis D. Kostakis, Diamantis I. Tsilimigras, Eliza W. Beal, Alexandros Papalampros, Dimitrios Dimitroulis, Evangelos Felekouras, and Timothy M. Pawlik. “Operative Results and Oncologic Outcomes of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Versus Two-Stage Hepatectomy (TSH) in Patients with Unresectable Colorectal Liver Metastases: A Systematic Review and Meta-Analysis.World Journal of Surgery 42, no. 3 (March 2018): 806–15. https://doi.org/10.1007/s00268-017-4181-6.
Moris D, Ronnekleiv-Kelly S, Kostakis ID, Tsilimigras DI, Beal EW, Papalampros A, Dimitroulis D, Felekouras E, Pawlik TM. Operative Results and Oncologic Outcomes of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Versus Two-Stage Hepatectomy (TSH) in Patients with Unresectable Colorectal Liver Metastases: A Systematic Review and Meta-Analysis. World journal of surgery. 2018 Mar;42(3):806–815.
Journal cover image

Published In

World journal of surgery

DOI

EISSN

1432-2323

ISSN

0364-2313

Publication Date

March 2018

Volume

42

Issue

3

Start / End Page

806 / 815

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Postoperative Complications
  • Portal Vein
  • Liver Neoplasms
  • Ligation
  • Humans
  • Hepatectomy
  • Colorectal Neoplasms
  • Adenocarcinoma