Elsevier

Surgery

Volume 157, Issue 4, April 2015, Pages 690-698
Surgery

Liver
A systematic review and meta-analysis of portal vein ligation versus portal vein embolization for elective liver resection

https://doi.org/10.1016/j.surg.2014.12.009Get rights and content

Introduction

This meta-analysis aimed to review the percentage increase in future liver remnant (FLR) and perioperative outcomes after portal vein ligation (PVL) and portal vein embolization (PVE) before liver resection.

Methods

An electronic search was performed of the MEDLINE, EMBASE, and PubMed databases using both subject headings (MeSH) and truncated word searches to identify all articles published that related to this topic. Pooled risk ratios were calculated for categorical outcomes and mean differences for secondary continuous outcomes using the fixed-effects and random-effects models for meta-analysis.

Results

Seven studies involving 218 patients met the inclusion criteria. There was no difference in the increase in FLR between the 2 groups 39% (PVE) versus 27% (PVL; mean difference [MD] 6.04; 95% CI, −0.23, 12.32; Z = 1.89; P = .06). Similarly, there was no difference in the morbidity (risk ratio [RR], 1.08; 95% CI, 0.55, 2.09; Z = 0.21; P = .83) and mortality (RR, 0.87; 95% CI, 0.19, 3.92; Z = 0.18; P = .85) in the 2 groups after liver resection. While awaiting liver resection after PVL and PVE, no difference was noted in the number of patients developing disease progression (RR, 0.93; 95% CI, 0.52, 1.66; Z = 0.24; P = .81). In a subset analysis comparing FLR with PVE and PVL as part of the procedure called an associating liver partition with PVL for staged hepatectomy (ALPPS), there was a significant increase in FLR in favor of ALPPS (MD, −17.09; 95% CI, −32.78, −1.40; Z = 2.14; P = .03).

Conclusion

PVL and PVE result in comparable percentage increase in FLR with similar morbidity and mortality rates. The ALPPS procedure results in an improved percentage increase in FLR compared with PVE alone.

Section snippets

Methods

Randomized and case-controlled studies, irrespective of language, country of origin, hospital, blinding, sample size, or publication status, that compared the use of PVL and PVE for elective liver resection were included in this review. The Cochrane Colorectal Cancer Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE, Embase, and Science Citation Index Expanded were searched for articles published up to January 2014 using the

Results

The strategies of the literature search and the selection of studies are summarized in Fig 1. Nine studies were included in the meta-analysis. Seven studies comparing PVE and PVL and 2 studies comparing PVE with ALPPS procedure met the inclusion criteria.8, 14, 15, 23, 24, 25, 26, 27, 28 All studies were retrospective. The 7 studies involved 218 patients, of whom 89 were in the PVL group and 129 in the PVE group. The quality and characteristics of the included studies are summarized in the Table

Discussion

Despite advances in the multimodality treatment of liver neoplasms and improvements in chemotherapeutic regimens, management of patients with liver neoplasms remains challenging, especially those with potentially inadequate FLR.14, 29, 30 Over the past few years, PVE and more recently PVL have been employed with varying success to achieve adequate FLR with some studies showing PVL to be less efficient24, 25, 30, 31 than PVE, whereas others showed comparable results.15, 23 This meta-analysis

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