• Victor Lopez-Lopez, Ricardo Robles-Campos, Roberto Brusadin, Asunción Lopez-Conesa, Jesus de la Peña, Albert Caballero, Julio Arevalo-Perez, Alvaro Navarro-Barrios, Paula Gómez, and Pascual Parrilla-Paricio.
• Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain.
• Ann Transl Med. 2019 Nov 1; 7 (22): 691.

AbstractHepatocellular carcinoma (HCC) is one of the most common and malignant tumors. Preoperative portal vein embolization (PVE) is currently the most accepted treatment before major hepatic resection for HCC in patients with liver fibrosis or cirrhosis and associated insufficient future liver remnant (FLR). In the last decade, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique has been described to obtain an increase of volume regarding PVE and a decrease of drop out. The initial excessive morbidity and mortality of this technique have decreased drastically due to a better selection of patients, the learning curve and the use of less aggressive variations of the original technique in the first stage. For both techniques a complete preoperative assessment of the FLR is the most important issue and only patients with and adequate FLR should be resected. ALPPS could be a feasible technique in very selected patients with HCC and cirrhosis. As long as it is performed in an experienced center could be used as a first choice technique versus PVE or could be used as a rescue technique in case of PVE failure.2019 Annals of Translational Medicine. All rights reserved.

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