Dealing with insufficient liver remnant: Associating liver partition and portal vein ligation for staged hepatectomy

Abstract

Liver resection for colorectal liver metastases has emerged to highly successful treatment in the last decades. Key to this success is complete hepatic tumor removal and systemic disease control by chemotherapy. Associating liver partition and portal vein ligation for staged hepatectomy is the most recent two‐stage resection strategy for patients with very small future liver remnant making complete tumor removal possible within 1 to 2 weeks. Oncological outcome data are being collected at the moment and first results from small series reveal promising results.

Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: State of the art of parenchyma augmentation–assisted liver surgery

“…In other words, ALPPS was able to markedly increase the number of potentially curative resections compared to PVE and TSH (Fig. 7 ) [ 76 ]. This advantage of ALPPS has led to a universal application for patients with different tumor entities and risk profiles in many centers.…”

Impact of sarcopenia on the future liver remnant growth after portal vein embolization and associating liver partition and portal vein ligation for staged hepatectomy in patients with liver cancer: A systematic review

“…However, many patients have been at an advanced stage at first diagnosis, and only 15-25% of patients are indicative of liver resection ( 2 ). For those patients who are not eligible for surgery, a majority of them are due to the limited future liver remnant (FLR), which is the remaining part of the liver after liver resection, and it serves as a key determinant for extended liver resection ( 3 ). FLR has to be sufficient to maintain normal physiologic function after liver resection, otherwise a lethal complication, post-hepatectomy liver failure will occur ( 4 ).…”

Rescue radiofrequency ablation or percutaneous ethanol injection: a strategy for failed RALPPS stage-1 in patients with cirrhosis-related hepatocellular carcinoma

“…alpps. net) [11]. The major concerns about HCC include the poor liver function reserve associated with HCC, due to chronic liver inflammation and compromised growth capacity affected by liver fibrosis/cirrhosis.…”

“…Presently, ALPPS or its variants are mainly performed in patients with colorectal liver metastases (CRLM), whereas few studies focus on hepatocellular carcinoma (HCC) (64% versus 14% according to the international ALPPS registry www.alpps.net ) [ 11 ]. The major concerns about HCC include the poor liver function reserve associated with HCC, due to chronic liver inflammation and compromised growth capacity affected by liver fibrosis/cirrhosis.…”