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

Lookup NU author(s): Professor Sanjay PandanaboyanaORCiD

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Abstract

© 2015 Elsevier Inc. All rights reserved.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.

Publication metadata

Author(s): Pandanaboyana S, Bell R, Hidalgo E, Toogood G, Prasad KR, Bartlett A, Lodge JP

Publication type: Article

Publication status: Published

Journal: Surgery

Year: 2015

Volume: 157

Issue: 4

Pages: 690-698

Print publication date: 01/04/2015

Online publication date: 20/02/2015

Acceptance date: 12/12/2014

ISSN (print): 0039-6060

ISSN (electronic): 1532-7361

Publisher: Mosby Inc.

URL: https://doi.org/10.1016/j.surg.2014.12.009

DOI: 10.1016/j.surg.2014.12.009

PubMed id: 25704417

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