[The role and evaluation of ALPPS in surgical treatment of hepatocellular carcinoma in the era of conversion therapy].

Authors

R Zhou, Y J Chen

Published in

Zhonghua wai ke za zhi [Chinese journal of surgery]. Volume 64. Issue 10. Pages 1027-1034. Aug 31, 2026. Epub Aug 31, 2026.

Abstract

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) offers a curative surgical opportunity for patients with initially unresectable hepatocellular carcinoma (HCC) and insufficient future liver remnant(FLR), owing to its unique advantage of rapidly inducing FLR hypertrophy. With breakthrough advances in first-line systemic therapies for advanced HCC-including immune checkpoint inhibitor-antiangiogenic combinations, dual immunotherapy regimens, and locoregional combined with systemic therapies-conversion therapy has emerged as a pivotal strategy in liver surgery, and the integration of ALPPS with HCC conversion therapy has advanced its clinical application into a more individualized era. This article systematically analyzes the evolving role of ALPPS in the era of conversion therapy and delineates four distinct clinical application modalities:(1) conventional staged ALPPS aimed at improving the surgical resection rate;(2) salvage ALPPS for patients with persistently insufficient FLR following HCC conversion therapy;(3) the"dual conversion"strategy, in which stage Ⅰ liver partition is followed by systemic conversion therapy prior to stage Ⅱ hepatectomy, thereby achieving concurrent oncological and surgical conversion;(4) conversion therapy followed by portal vein embolization (PVE) as a minimally invasive approach, with salvage ALPPS as a rescue option when PVE-induced hypertrophy proves insufficient. The rationale for selecting among these four modalities is further elaborated across multiple dimensions, including the severity of FLR insufficiency, tumor burden and response to conversion therapy, and patient-specific conditions. The organic integration of surgical innovation with oncological advances, together with precise and individualized decision-making within a multidisciplinary team framework, holds the promise of achieving the transition from "unresectable" to "resectable", and ultimately from "tumor-bearing survival" to "tumor-free，drug-free，high-quality survival".

PMID:
42669436
Bibliographic data and abstract were imported from PubMed on 31 Aug 2026.

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