Variations and adaptations of associating liver partition and portal vein ligation for staged hepatectomy with the gui dance of damage control surgery

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is used for patients with advanced hepatocellular carcinoma who cannot tolerate major hepatectomy due to an insufficient future liver remnant, but the morbidity and mortality rate in the perioperative period are still high. Available studies indicate that damage control surgery variations such as laparoscopic procedure and associating radiofrequency/microwave ablation/liver tourniquet and portal vein ligation could improve the morbidity and mortality associated with ALPPS, as could portal vein embolization. However, randomized controlled trials are needed to determine benefits in technical variations.