Related Experiment Video
Updated: May 27, 2026
Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Procedure
Published on: August 14, 2017
ALPPS VS PVE VS LVD: selecting the optimal liver hypertrophy method for patients with liver malignancies, before
Afroditi Fotiadou1, Kyriacos Evangelou2, Nikolaos Arkadopoulos3
1Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
Background:
Large scale hepatectomy for primary or metastatic liver tumors may be limited by insufficient Future Liver Remnant (FLR). Strategies to enhance FLR hypertrophy include associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), portal vein embolization (PVE), and Liver Venous Deprivation (LVD). Their comparative efficacy in the context of open hepatectomy remains unclear.
Methods:
A systematic review and meta-analysis of pairwise comparative studies was conducted (PubMed, Embase, Scopus, Cochrane). Risk of bias was assessed using ROBINS-I. Random-effects models were applied, with p < 0.05 considered significant.
Results:
24 retrospective cohort studies with a total of 1263 patients were included, with 1/3 judged as moderate and the rest as severe overall risk of bias. ALPPS induced higher mean Kinetic Growth Rate (KGR) than PVE (SMD = 1.61; 95%CI = 1.23,1.99; p < 0.01) and LVD (ROM = 3.15; 95%CI = 2.66,3.71, p < 0.01), and LVD than PVE (ROM = 1.96; 95%CI = 1.75,2.22; p < 0.01). ALPPS was associated with superior hepatectomy completion rates compared to PVE (OR = 13.75; 95%CI = 3.24,58.57; p < 0.01), and worse 1-year DFS (OR = 0.45; 95%CI = 0.21,0.93; p = 0.03). The rest of the comparisons failed to reach statistical significance.
Conclusion:
ALPPS seems to induce the most rapid FLR hypertrophy, but no substantial differences regarding postoperative outcomes were observed. Further, ideally randomised, studies are necessary to draw clear and clinically relevant conclusions.
