Advances of associating liver partition and portal vein ligation for staged hepatectomy in the treatment of primarilly unresectable liver cancer

In recent years, the systematic treatment of liver cancer has made significant progress, but surgical resection remains as main treatment to obtain long-term survival for patients with liver cancer. With the rapid development of liver surgery, the complexity of liver anatomy and surgical operation are no longer the main obstacles to liver surgery. The insufficient future liver remnant (FLR) after hepatectomy has become the main limit of liver surgery. In clinical practice, most patients with liver cancer cannot undergo one-stage radical resection and can only receive non-surgical treatment, with poor long-term prognosis. The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) provides hope for the treatment of liver cancer patients with insufficient FLR. ALPPS can induce significant hypotrophy of the FLR in a short period of time, and the radical tumor resection rate is as high as 90% to 100%, which significantly improves the prognosis of patients. However, in the early stages of the practice, there were considerable controversies on the safety of the operation. In recent years, with the continuous advancement of technology, the safety of ALPPS has been greatly improved. The authors synthesize the latest literatures and elaborate on the latest progress of ALPPS.