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Volume 41 Issue 10
Oct.  2025
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Article Navigation >  Journal of Clinical Hepatology  > 2025  >  41(10): 2168-2173

Current status and perspectives of the application of two-stage hepatectomy for insufficient future liver remnant volume

DOI: 10.12449/JCH251031

  • Department of Hepatobiliary Pancreatic Surgery，The First People’s Hospital of Kunming/The Affiliated Calmette Hospital of Kunming Medical University，Kunming 650100，China

Research funding:

Major Science and Technology Project of Yunnan Provincial Science and Technology Department (202302AA310018)

More Information
  • Corresponding author: GAO Hongqiang， 13708466595@163.com （ORCID： 0000-0002-2078-4303）
  • Received Date: 2025-02-20
  • Accepted Date: 2025-03-28
  • Published Date: 2025-10-25
    Abstract
  • Insufficient future liver remnant volume remains a critical limitation for single-stage resection in patients with hepatic malignancies. The techniques for promoting future liver remnant hypertrophy to realize two-stage hepatectomy include portal vein embolization， associating liver partition and portal vein ligation for staged hepatectomy， and portal vein ligation. In recent years， the application of auxiliary liver transplantation has further facilitated two-stage total hepatectomy. This article systematically reviews the clinical applications of these techniques and analyzes their advantages and limitations， so as to provide a reference for optimizing clinical decision-making.

     

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  • [1]
    HAO Y, LI C, WEN TF, et al. Epidemiological characteristics of liver cancer worldwide and in China: An interpretation of global cancer statistics 2022[J]. Chin J Bases Clin Gen Surg, 2024, 31( 7): 781- 789. DOI: 10.7507/1007-9424.

    郝运, 李川, 文天夫, 等. 全球及中国的肝癌流行病学特征: 基于《2022全球癌症统计报告》解读[J]. 中国普外基础与临床杂志, 2024, 31( 7): 781- 789. DOI: 10.7507/1007-9424.
    [2]
    WANG H, YAO XX, QIAO SX. Controversies over the extent of surgical resection for hilar cholangiocarcinoma and research advances in diagnosis and treatment[J]. J Clin Hepatol, 2020, 36( 3): 704- 707. DOI: 10.3969/j.issn.1001-5256.2020.03.053.

    汪宏, 姚小晓, 乔士兴. 肝门部胆管癌手术切除范围的争议及诊疗进展[J]. 临床肝胆病杂志, 2020, 36( 3): 704- 707. DOI: 10.3969/j.issn.1001-5256.2020.03.053.
    [3]
    BAKOS A, LIBOR L, URBÁN S, et al. Dynamic[99mTc] Tc-mebrofenin SPECT/CT in preoperative planning of liver resection: A prospective study[J]. Sci Rep, 2024, 14( 1): 30305. DOI: 10.1038/s41598-024-81331-z.
    [4]
    SPARRELID E, OLTHOF PB, DASARI BVM, et al. Current evidence on posthepatectomy liver failure: Comprehensive review[J]. BJS Open, 2022, 6( 6): zrac142. DOI: 10.1093/bjsopen/zrac142.
    [5]
    BELL R, BEGUM S, PRASAD R, et al. Volume and flow modulation strategies to mitigate post-hepatectomy liver failure[J]. Front Oncol, 2022, 12: 1021018. DOI: 10.3389/fonc.2022.1021018.
    [6]
    AYABE RI, VAUTHEY JN, NEWHOOK TE. Optimizing the future liver remnant: Portal vein embolization, hepatic venous deprivation, and associating liver partition and portal vein ligation for staged hepatectomy[J]. Surgery, 2023, 174( 1): 116- 118. DOI: 10.1016/j.surg.2023.02.031.
    [7]
    LIM C, TURCO C, BALCI D, et al. Auxiliary liver transplantation for cirrhosis: From APOLT to RAPID: A scoping review[J]. Ann Surg, 2022, 275( 3): 551- 559. DOI: 10.1097/SLA.0000000000005336.
    [8]
    CHARLES J, NEZAMI N, LOYA M, et al. Portal vein embolization: Rationale, techniques, and outcomes to maximize remnant liver hypertrophy with a focus on contemporary strategies[J]. Life(Basel), 2023, 13( 2): 279. DOI: 10.3390/life13020279.
    [9]
    SIVAKUMAR I, LIDDELL RP. A review of portal vein embolization prior to hepatic resection[J]. J Surg Oncol, 2024, 130( 3): 435- 442. DOI: 10.1002/jso.27738.
    [10]
    ZHOU J, PENG YF, WANG Z. Surgical treatment of liver cancer with insufficient future liver remnant:controversy and consensus[J]. Chin J Pract Surg, 2018, 38( 2): 126- 132. DOI: 10.19538/j.cjps.issn1005-2208.2018.02.02.

    周俭, 彭远飞, 王征. 余肝不足肝癌手术治疗争议与共识[J]. 中国实用外科杂志, 2018, 38( 2): 126- 132. DOI: 10.19538/j.cjps.issn1005-2208.2018.02.02.
    [11]
    NAKANUMA S, OGI T, SUGITA H, et al. Impact of aging on hepatic reserve after preoperative portal vein embolization in hepatectomy for perihilar cholangiocarcinoma[J]. Asian J Surg, 2025, 48( 2): 1010- 1015. DOI: 10.1016/j.asjsur.2024.10.152.
    [12]
    KORENBLIK R, JFJA VAN ZON, OLIJ B, et al. Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: Meta-analysis[J]. BJS Open, 2022, 6( 6): zrac141. DOI: 10.1093/bjsopen/zrac141.
    [13]
    CASSESE G, HAN HS, LEE B, et al. Portal vein embolization failure: Current strategies and future perspectives to improve liver hypertrophy before major oncological liver resection[J]. World J Gastrointest Oncol, 2022, 14( 11): 2088- 2096. DOI: 10.4251/wjgo.v14.i11.2088.
    [14]
    KIM D, CORNMAN-HOMONOFF J, MADOFF DC. Preparing for liver surgery with“alphabet soup”: PVE, ALPPS, TAE-PVE, LVD and RL[J]. Hepatobiliary Surg Nutr, 2020, 9( 2): 136- 151. DOI: 10.21037/hbsn.2019.09.10.
    [15]
    KIMURA K, MINAGAWA R, YAMAOKA T, et al. Transileocolic portal vein embolization increases remnant liver volume after major hepatectomy[J]. In Vivo, 2024, 38( 6): 2761- 2766. DOI: 10.21873/invivo.13755.
    [16]
    OKADA M, IHARA K, MIYOSHI K, et al. Portal vein embolization via the ipsilateral percutaneous transhepatic approach versus laparotomic transileocecal approach: Complications, profile and changes in future liver remnant volume[J]. Br J Radiol, 2022, 95( 1135): 20210854. DOI: 10.1259/bjr.20210854.
    [17]
    BOZKURT E, SIJBERDEN JP, LANGELLA S, et al. Laparoscopic versus open right hepatectomy for colorectal liver metastases after portal vein embolization: International multicentre study[J]. Br J Surg, 2024, 111( 8): znae181. DOI: 10.1093/bjs/znae181.
    [18]
    LEE YH, LAI YC, HSU MY, et al. Central vascular plug-assisted portal vein embolization with absolute ethanol[J]. Clin Radiol, 2025, 80: 106755. DOI: 10.1016/j.crad.2024.106755.
    [19]
    NI JS, LI Y, LI HF, et al. Clinical efficacy of portal vein embolization with different embolization materials in patients with initially unresectable hepatocellular carcinoma[J]. Chin J Hepatobiliary Surg, 2023, 29( 6): 406- 411. DOI: 10.3760/cma.j.cn113884-20230411-00114.

    倪俊声, 李曜, 李慧芬, 等. 不同栓塞材料的门静脉栓塞术治疗初始不可切除肝细胞癌患者的临床疗效观察[J]. 中华肝胆外科杂志, 2023, 29( 6): 406- 411. DOI: 10.3760/cma.j.cn113884-20230411-00114.
    [20]
    BJÖRK D, DELLE M, HOLMQUIST F, et al. Portal vein embolization with N-butyl-cyanoacrylate improves liver hypertrophy compared to microparticles-A Swedish multicenter cohort study[J]. Heliyon, 2023, 9( 11): e21210. DOI: 10.1016/j.heliyon.2023.e21210.
    [21]
    CEVIK E, ALBADAWI H, ZHANG ZF, et al. Catheter-directed ionic liquid embolic agent for rapid portal vein embolization, segmentectomy, and bile duct ablation[J]. Adv Mater, 2024, 36( 29): e2402570. DOI: 10.1002/adma.202402570.
    [22]
    NI JS, LI Y, LIU X, et al. Influence of PVE and PVE combined with TACE on secondary hepatectomy and prognosis of hepatocellular carcinoma[J]. Chin J Dig Surg, 2024, 23( 2): 257- 264. DOI: 10.3760/cma.j.cn11561-0-20231201-00228.

    倪俊声, 李曜, 刘学, 等. PVE或PVE联合TACE对肝细胞癌二期手术及预后的影响[J]. 中华消化外科杂志, 2024, 23( 2): 257- 264. DOI: 10.3760/cma.j.cn115610-20231201-00228.
    [23]
    YAN Q, WANG FJ, HE JW, et al. Trans-arterial chemo-emobilization(TACE) combined with laparoscopic portal vein ligation and terminal branches portal vein embolization for hepatocellular carcinoma: A novel conversion strategy[J]. J Gastrointest Oncol, 2024, 15( 5): 2178- 2186. DOI: 10.21037/jgo-24-507.
    [24]
    de SANTIBAÑES E, CLAVIEN PA. Playing play-doh to prevent postoperative liver failure: The“ALPPS” approach[J]. Ann Surg, 2012, 255( 3): 415- 417. DOI: 10.1097/SLA.0b013e318248577d.
    [25]
    SCHNITZBAUER AA, LANG SA, GOESSMANN H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings[J]. Ann Surg, 2012, 255( 3): 405- 414. DOI: 10.1097/SLA.0b013e31824856f5.
    [26]
    LIU YY, LIU XX. Surgical modifications on the conventional ALPPS[J]. Chin J Pract Surg, 2016, 36( 1): 93- 95. DOI: 10.7504/CJPS.ISSN1005-2208.2016.01.25.

    刘允怡, 刘晓欣. 对联合肝脏分隔和门静脉结扎的二步肝切除术评价——兼评洪德飞教授文章[J]. 中国实用外科杂志, 2016, 36( 1): 93- 95. DOI: 10.7504/CJPS.ISSN1005-2208.2016.01.25.
    [27]
    FERRI JVV, FEIER FH, SCAFFARO LA, et al. Salvage alpps procedure for failed portal vein embolization[J]. Arq Bras Cir Dig, 2023, 36: e1776. DOI: 10.1590/0102-672020230058e1776.
    [28]
    BERARDI G, GUGLIELMO N, COLASANTI M, et al. Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) for advanced hepatocellular carcinoma with macrovascular invasion[J]. Updates Surg, 2022, 74( 3): 927- 936. DOI: 10.1007/s13304-022-01277-7.
    [29]
    ZHANG JW, ZHANG L, YANG XB, et al. Liver fibrosis as a predictor of liver failure and outcome following ALPPS among patients with primary liver cancer[J]. Sci Rep, 2024, 14( 1): 15827. DOI: 10.1038/s41598-024-65924-2.
    [30]
    MACHADO MAC, MAKDISSI FF, SURJAN RC. Totally laparoscopic ALPPS is feasible and may be worthwhile[J]. Ann Surg, 2012, 256( 3): e13. DOI: 10.1097/SLA.0b013e318265ff2e.
    [31]
    VICENTE E, QUIJANO Y, IELPO B, et al. First ALPPS procedure using a total robotic approach[J]. Surg Oncol, 2016, 25( 4): 457. DOI: 10.1016/j.suronc.2015.10.001.
    [32]
    LOKE S, ONG BDC, NG J, et al. Safety and efficacy of minimally invasive associating liver partition and portal vein ligation for staged hepatectomy(ALPPS): A systematic review and meta-analysis[J]. Int J Surg, 2025, 111( 2): 2283- 2290. DOI: 10.1097/JS9.0000000000002240.
    [33]
    HONG DF, ZHANG YB, PENG SY, et al. Percutaneous microwave ablation liver partition and portal vein embolization for rapid liver regeneration: A minimally invasive first step of ALPPS for hepatocellular carcinoma[J]. Ann Surg, 2016, 264( 1): e1- e2. DOI: 10.1097/SLA.0000000-000001707.
    [34]
    YE TW, FU TW, DU CF, et al. Comparison of percutaneous microwave/radiofrequency ablation liver partition and portal vein embolization versus transarterial chemoembolization and portal vein embolization for planned hepatectomy with insufficient future liver remnant[J]. BMC Cancer, 2024, 24( 1): 985. DOI: 10.1186/s12885-024-12666-z.
    [35]
    YANG HG, HU ZM, XU JZ, et al. Clinical efficacy of TACE combined with PVE versus percutaneous microwave ablation liver partition with PVE for planned hepatectomy for hepatocellular carcinoma with insufficient remnant liver volume[J]. Chin J Hepatobiliary Surg, 2023, 29( 6): 418- 422. DOI: 10.3760/cma.j.cn113884-20230407-00103.

    杨鸿国, 胡智明, 徐嘉泽, 等. TACE联合门静脉栓塞术与微波消融肝脏分隔联合门静脉栓塞术治疗剩余肝体积不足肝细胞癌的临床疗效[J]. 中华肝胆外科杂志, 2023, 29( 6): 418- 422. DOI: 10.3760/cma.j.cn113884-20230407-00103.
    [36]
    GIRARD E, TRILLING B, CHIRICA M. Comment on: Liver venous deprivation(LVD) or associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)? A retrospective multicentric study[J]. Hepatobiliary Surg Nutr, 2021, 10( 5): 675- 677. DOI: 10.21037/hbsn-21-381.
    [37]
    HWANG S, LEE SG, KO GY, et al. Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy[J]. Ann Surg, 2009, 249( 4): 608- 616. DOI: 10.1097/SLA.0b013e31819ecc5c.
    [38]
    GUIU B, CHEVALLIER P, DENYS A, et al. Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: The liver venous deprivation technique[J]. Eur Radiol, 2016, 26( 12): 4259- 4267. DOI: 10.1007/s00330-016-4291-9.
    [39]
    GUIU B, QUENET F, ESCAL L, et al. Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function[J]. Eur Radiol, 2017, 27( 8): 3343- 3352. DOI: 10.1007/s00330-017-4744-9.
    [40]
    HE BS, XIAO M, ZHANG JQ, et al. Research advances in liver venous deprivation[J]. J Clin Hepatol, 2025, 41( 1): 183- 188. DOI: 10.12449/JCH250128.

    贺本松, 肖鸣, 张琪佳, 等. 肝静脉剥夺术的研究进展[J]. 临床肝胆病杂志, 2025, 41( 1): 183- 188. DOI: 10.12449/JCH250128.
    [41]
    LE ROY B, PERREY A, FONTARENSKY M, et al. Combined preoperative portal and hepatic vein embolization(biembolization) to improve liver regeneration before major liver resection: A preliminary report[J]. World J Surg, 2017, 41( 7): 1848- 1856. DOI: 10.1007/s00268-017-4016-5.
    [42]
    DELLA CORTE A, SANTANGELO D, AUGELLO L, et al. Single-center retrospective study comparing double vein embolization via a trans-jugular approach with liver venous deprivation via a trans-hepatic approach[J]. Cardiovasc Intervent Radiol, 2023, 46( 12): 1703- 1712. DOI: 10.1007/s00270-023-03538-3.
    [43]
    GAVRIILIDIS P, MARANGONI G, AHMAD J, et al. Simultaneous portal and hepatic vein embolization is better than portal embolization or ALPPS for hypertrophy of future liver remnant before major hepatectomy: A systematic review and network meta-analysis[J]. Hepatobiliary Pancreat Dis Int, 2023, 22( 3): 221- 227. DOI: 10.1016/j.hbpd.2022.08.013.
    [44]
    YANG LP, YANG M, WANG T, et al. Comparison of liver venous deprivation with portal vein embolization alone in patients undergoing major liver resection: A systematic review and meta-analysis[J]. HPB(Oxford), 2024, 26( 11): 1329- 1338. DOI: 10.1016/j.hpb.2024.07.409.
    [45]
    HADDAD A, KHAVANDI MM, LENDOIRE M, et al. Propensity score-matched analysis of liver venous deprivation and portal vein embolization before planned hepatectomy in patients with extensive colorectal liver metastases and high-risk factors for inadequate regeneration[J]. Ann Surg Oncol, 2025, 32( 3): 1752- 1761. DOI: 10.1245/s10434-024-16558-1.
    [46]
    PHAM AT, DANG QH, TRUONG CM, et al. Additional hepatic artery embolization after liver venous deprivation for right hepatectomy: A case report[J]. Radiol Case Rep, 2024, 19( 9): 3672- 3676. DOI: 10.1016/j.radcr.2024.05.078.
    [47]
    CHEBARO A, BUC E, DURIN T, et al. Liver venous deprivation or associating liver partition and portal vein ligation for staged hepatectomy?: A retrospective multicentric study[J]. Ann Surg, 2021, 274( 5): 874- 880. DOI: 10.1097/SLA.0000000000005121.
    [48]
    JAMES S, SMITS J, van der VELDEN AL, et al. Invited commentary on“CIRSE standards of practice on portal vein embolization and double vein embolization/liver venous deprivation”[J]. Cardiovasc Intervent Radiol, 2024, 47( 9): 1311- 1312. DOI: 10.1007/s00270-024-03815-9.
    [49]
    LINE PD, HAGNESS M, BERSTAD AE, et al. A novel concept for partial liver transplantation in nonresectable colorectal liver metastases: The RAPID concept[J]. Ann Surg, 2015, 262( 1): e5- e9. DOI: 10.1097/SLA.0000000000001165.
    [50]
    KÖNIGSRAINER A, TEMPLIN S, CAPOBIANCO I, et al. Paradigm shift in the management of irresectable colorectal liver metastases: Living donor auxiliary partial orthotopic liver transplantation in combination with two-stage hepatectomy(LD-RAPID)[J]. Ann Surg, 2019, 270( 2): 327- 332. DOI: 10.1097/SLA.0000000000002861.
    [51]
    ZHANG PF, CHEN YJ, CAO JL, et al. Value of hepatic venous pressure gradient in preoperative evaluation and prognosis prediction in liver transplant recipients[J]. Organ Transplant, 2023, 14( 1): 154- 159. DOI: 10.3969/j.issn.1674-7445.2023.01.021.

    张鹏飞, 陈雅洁, 曹经琳, 等. 肝静脉压力梯度对肝移植受者术前评估及预后预测的价值[J]. 器官移植, 2023, 14( 1): 154- 159. DOI: 10.3969/j.issn.1674-7445.2023.01.021.
    [52]
    RAVAIOLI M, FALLANI G, CESCON M, et al. Heterotopic auxiliary segment 2-3 liver transplantation with delayed total hepatectomy: New strategies for nonresectable colorectal liver metastases[J]. Surgery, 2018, 164( 3): 601- 603. DOI: 10.1016/j.surg.2018.05.021.
    [53]
    RAVAIOLI M, BRANDI G, SINISCALCHI A, et al. Heterotopic segmental liver transplantation on splenic vessels after splenectomy with delayed native hepatectomy after graft regeneration: A new technique to enhance liver transplantation[J]. Am J Transplant, 2021, 21( 2): 870- 875. DOI: 10.1111/ajt.16222.
    [54]
    RAMMOHAN A, REDDY MS, LINE PD, et al. Heterotopic liver transplantation: Temporary solution, permanent problem?[J]. Am J Transplant, 2021, 21( 2): 903- 904. DOI: 10.1111/ajt.16271.
    [55]
    RAVAIOLI M, GERMINARIO G, CERRI M, et al. Venous outflow in partial heterotopic liver transplantation with spleen replacement: Evidence of no chronic venous hypertension[J]. Am J Transplant, 2022, 22( 2): 664- 665. DOI: 10.1111/ajt.16800.
    [56]
    LI X, CAO WW, YU L. Exploratory road of liver xenotransplantation: from scientific research to clinical application[J]. Ogran Transplant, 2024, 15( 5): 758- 763. DOI: 10.3969/j.issn.1674-7445.2024043.

    李霄, 曹薇薇, 余良. 异种肝移植的探索之路:从科学研究走向临床应用[J]. 器官移植, 2024, 15( 5): 758- 763. DOI: 10.3969/j.issn.1674-7445.2024043.
    [57]
    PRIMAVESI F, MAGLIONE M, CIPRIANI F, et al. E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy[J]. Br J Surg, 2023, 110( 10): 1331- 1347. DOI: 10.1093/bjs/znad233.
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