Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 28, 2015; 7(18): 2147-2154
Published online Aug 28, 2015. doi: 10.4254/wjh.v7.i18.2147
Strategies to increase the resectability of hepatocellular carcinoma
Wong Hoi She, Kenneth SH Chok
Wong Hoi She, Kenneth SH Chok, Department of Surgery, the University of Hong Kong, Hong Kong, China
Author contributions: She WH drafted the manuscript; Chok KSH reviewed the manuscript; both of them approved the submitted version of the manuscript.
Conflict-of-interest statement: None of the authors has any conflict of interest with regard to the study or its publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Kenneth SH Chok, MBBS, Department of Surgery, the University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
Telephone: +852-22553025 Fax: +852-28165284
Received: April 27, 2015
Peer-review started: April 30, 2015
First decision: July 25, 2015
Revised: August 10, 2015
Accepted: August 20, 2015
Article in press: August 21, 2015
Published online: August 28, 2015
Core Tip

Core tip: There are different ways to increase the resectability of hepatocellular carcinoma by increasing the volume of the future liver remnant (FLR) through hypertrophy. Portal vein embolization features the the embolization of the ipsilateral side of the portal vein which supplies the liver lobe harboring the tumor, either in an open or percutaneous manner. Sequential transarterial chemoembolization and portal vein embolization is a way to augment the effect of portal vein embolization and prevent tumor progression. Staged hepatectomy is mainly for liver tumors with bilobar involvement and colorectal liver metastasis and is often aided by effective adjuvant chemotherapy. Its aim is to strike a balance between complete tumor removal and preservation of the FLR. Two-staged hepatectomy with portal vein ligation is also mainly for liver tumors with bilobar involvement and colorectal liver metastasis. In the first-stage operation, tumor in the liver portion which is designated as the FLR is cleared, and portal vein ligation is performed. The liver parenchyma is transected only in the second-stage operation. Associating Liver Partition and Portal Vein Ligation in Staged Hepatectomy is used to speed up hypertrophy in the hope that the FLR will grow large enough for a safe hepatectomy before tumor progression occurs. It features right portal vein ligation and in-situ splitting of the intended transection surface down to the inferior vena cava. In the first-stage operation, the anterior approach is encouraged and the Pringle maneuver is discouraged, and the hilar plate is left untouched.