Current status of associating liver partition with portal vein ligation for staged hepatectomy: Comparison with two-stage hepatectomy and strategies for better outcomes

Table 1 Associating liver partition with portal vein ligation for staged hepatectomy vs two-stage hepatectomy, n (%)

	n	Tumor	Preopera-tive FLR/ESL-V in %	FLR increase in %	Interval in d	Comple-te planned resection	Major morbidity, ≥ IIIa		PHLF, ≥ B	HM	OS	DFS
							Stage I	Stage II
Case control
Schadde et al[3], 2014	48/83	CRLM/HCC/CC	0.47/0.53b	-		48 (100)/54 (64)					-	-
Shindoh et al[4], 2013	25/144	CRLM/HCC/CC	-	74 (21-192) /62 (0-379)	9 (5-28) /31 (12-385)	-	10 (40)/34 (33)		-	3 (12) /6 (6)	-	-
Croome et al[5], 2015	15/53	CRLM/HCC/CC	20 ± 4/31 ± 14	84 ± 8/36 ± 27	-	15 (100) /42 (79)	-	-	2 (13) /12 (23)c	0/2 (4)	-	-
Ratti et al[6], 2015	12/36	CRLM	22/23	47/41	11/31	12 (100) /34 (94.4)	0/1 (2.8)	5 (42) /6 (18)d	0/2 (5.9)	1 (8.3) /1 (2.9)	1 yr: 92%/94%	1 yr: 67%/80%
Tanaka et al[8], 2015	11/54	CRLM/NET	34 ± 10/31 ± 10	52 (33-94)/22 (34-68)e	-	11 (100)/48 (89)	1 (9)/4 (8)	3 (27)/8 (17)	5 (45)/5 (9)	1 (9)/1 (2)	-	-
Adam et al[9], 2016	17/41	CRLM	24/30	50/33	12/103	17 (100)/26 (63.4)	4 (24)/7 (17)	4 (24)/10 (38)	0/1 (3.8)	0/2 (4.9)	2 yr: 42%/77%	1 yr: 0%/10%
Matsuo et al[11], 2016	8/14	CRLM/CC	-	-	11 ± 2/52 ± 33	-	1(13)/4 (29)		2 (25)/8 (57)	0/0	-	-
Chia et al[7], 2018	10/29	HCC/ CRLM	22 (12-29) /22 (15-32)	48 (39-97)/12 (4-42)	7 (7-9)/20 (18-29)	8 (80)/12 (59)	3 (30)f	2 (25)g/3 (17.6)h	2 (25)/0c	1 (3.4)/0	-	-
Meta-analysis
Zhou et al[12], 2017	201/518	-	-	WMD +40%	WMD -27%	97%/73%	OR 2.4i	OR 4.0i	10%/14%
Randomized controlled trial
Sandstrom et al[13], 2018j	48/49	CRLM	22.4 ± 4.3/21.2 ± 5.1	68 ± 38/36 ± 18	11 ± 11/43 ± 15	44 (92)/28 (57)	19 (43)/12 (43)k		4 (8.3)/3 (6.1)	4 (8.3)/3 (6.1)	-	-

^aAmong completed procedures.

^b Future liver remnant/body weight.

^c50-50 criteria.

^dBile leak (n = 1), intra-abdominal abscess (n = 3).

^eWeek 1.

^fPleural effusion (n = 2), wound dehiscence (n = 1).

^gPleural effusion (n = 1), post-hepatectomy liver failure (n = 1).

^hBowel ischemia (n = 1), acute renal failure (n = 1), pleural effusion (n = 1).

ⁱAll morbidity.

^jCombined results of portal vein embolization (n = 27) and staged hepatectomy (n = 22) compared with associating liver partition with portal vein ligation for staged hepatectomy (n = 48).

^kClavien-Dindo IIIa or above. CC: Cholangiocarcinoma; CRLM: Colorectal liver metastasis; Cx: Complications; DFS: Disease-free survival; ESLV: Estimated standard liver volume; FLR: Future liver remnant; HCC: Hepatocellular carcinoma; HM: Hospital mortality; NET: Neuroendocrine tumor; OS: Overall survival; PHLF: Post-hepatectomy liver failure; WMD: Weighed mean difference.

Table 2 Risk modelling proposed by Linecker et al[29]

Risk modelling	Risk points	OR (95%CI)
Pre-stage I variables
CRLM	0	1
Non-CRLM/non-biliary	1	1.925 (0.808-4.585)
Biliary	2	3.767 (1.800-7.822)
Age ≥ 67	3	5.668 (2.843-11.300)
Pre-stage II variables
Pre-stage I score	0.66	1.925 (1.527-2.426)
Inter-stage complications ≥3b	1.2	3.350 (1.280-8.769)
Bilirubin	1.5	4.439 (1.699-11.600)
Creatinine	1.7	5.454 (1.606-18.520)

CI: Confidence interval; CRLM: Colorectal liver metastasis; OR: Odds ratio.

Table 3 Associating liver partition with portal vein ligation for staged hepatectomy for hepatocellular carcinoma, n (%)

	n	Tumor	FLR in mL		Hypertrophy		Kinetic growth in %/d	Severe Cx, ≥ IIIB	PHLF, 50-50	90-d mortality
			Stage I	Stage II	Absolute in mL	Relative in %
Case control
D'Haese et al[38], 2016	35/225	HCC/CRLM	420 (346-540)/340 (260-433)	639 (541-855)/617 (487-724)	206 (172-277)/252 (186-348)	47 (26-69)/76 (50-108)	4.7 (2.8-8.9)/9.1 (5.8-14.3)	14 (27)/54 (17)	14 (40)/42 (19)	11 (31)/15 (7)
Chia et al[43], 2018	9/4	HCC/non-HCC	381 (280-422)/313 (177-550)	-	154 (86-166)/251 (248-344)	40 (22-65)/138 (92-139)	19 (6-24)/35 (31-39)	1 (14)/0	2 (29)/1 (25)	1 (11)/0

CRLM: Colorectal liver metastasis; Cx: Complication; FLR: Future liver remnant; HCC: Hepatocellular carcinoma; PHLF: Post-hepatectomy liver failure.