Related Experiment Video
Updated: Aug 26, 2025
Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy ALPPS Procedure
Published on: August 14, 2017
Promoting Surgical Resection through Future Liver Remnant Hypertrophy
Pouya Entezari1, Beau B Toskich1, Edward Kim1
1From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.).
Abstract:
An inadequate future liver remnant (FLR) can preclude curative-intent surgical resection for patients with primary or secondary hepatic malignancies. For patients with normal baseline liver function and without risk factors, an FLR of 20% is needed to maintain postsurgical hepatic function. However, the FLR requirement is higher for patients who are exposed to systemic chemotherapy (FLR, >30%) or have cirrhosis (FLR, >40%). Interventional radiologic and surgical methods to achieve FLR hypertrophy are evolving, including portal vein ligation, portal vein embolization, radiation lobectomy, hepatic venous deprivation, and associating liver partition and portal vein ligation for staged hepatectomy. Each technique offers particular advantages and disadvantages. Knowledge of these procedures can help clinicians to choose the suitable technique for each patient. The authors review the techniques used to develop FLR hypertrophy, focusing on technical considerations, outcomes, and the advantages and disadvantages of each approach. Online supplemental material is available for this article. ©RSNA, 2022.
