关键词: 肝癌, 余肝, 门静脉栓塞, 门静脉结扎, 经肝动脉化疗栓塞, 联合肝脏分隔和门静脉结扎的二步肝切除术

Abstract:

Surgical treatment of liver cancer with insufficient future liver remnant: controversy and consensus        ZHOU Jian,PENG Yuan-fei, WANG Zheng. Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Correspongding author: ZHOU Jian, E-mail: zhou.jian@
zs-hospital.sh.cn
Abstract    Hepatic resection is the main optimal curative treatment for primary or metastatic liver cancer. The tremendous advance in liver surgery has overcome the complexity of liver anatomy and operative manipulation, but is often halted by the insufficient future liver remnant (FLR) after extensive hepatectomies. Thus far, the artificial liver support system has not been well developed. The main strategies of resection for patients with insufficient FLR are two-stage hepatectomy (resection of tumor after induction of FLR hypertrophy) and downstaging/conversion therapy of prirmary or metastatic liver cancer. The conventional two-stage hepatectomy includes portal vein embolization (PVE) and portal vein ligation (PVL). In hepatocellular carcinoma patients, PVE combined with transarterial chemoembolization can further improve the outcomes. The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can significantly increase the resectability by achieving a rapid and an effective hypertrophy of the FLR, but the postoperative complication rate and mortality rate is higher，the safety and oncological results are still controversial. The downstaging/conversion therapy of primary or metastatic liver cancer have also been remarkably improved with the progression of non-surgical treatments, which has enabled more and more patients to benefit from surgery.

Key words: liver neoplasia；future liver remnant, portal vein embolization；portal vein ligation；transarterial chemoembolization；associating liver partition with portal vein ligation for staged hepatectomy