Development and application of resection and partial liver transplantation with delayed total hepatectomy

Liver is a common site for distant metastasis of colorectal cancer and a large proportion of patients with colorectal liver metastasis cannot receive the radical hepatectomy. Liver transplantation has been proven to bring a survival benefit in highly selected unresectable colorectal liver metastasis (u‑CRLM) patients, but the shortage of donor liver severely restricts its application. Resection and partial liver transplantation with delayed total hepatectomy (RAPID) is a newly deve-loped liver transplantation procedure, which innovatively combined auxiliary liver transplantation and associating liver partition and portal vein ligation for staged hepatectomy. With the small and partial liver graft, RAPID can cure u‑CRLM safely and effectively. In RAPID, the reconstruction of portal vein and hepatic vein is the key point, while the control of portal vein pressure and flow is the difficulty and also the key for success. Thereafter, living donor‑RAPID is created by combing RAPID with living donor liver transplantation. Besides, the application of RAPID also extends to other primary liver diseases, including liver cirrhosis and liver cancer. RAPID is difficult, complex and under an exploratory stage at present. In this paper, based on the developing process of RAPID, the authors give a comprehensive overview of its surgical procedures and key points, and discuss its potential application area.