Figure 2.

Scheme of staged hepatectomy for colorectal liver metastases. (A) Right‐first approach: most of the invaded hemiliver (usually the right lobe) is resected at the first stage, leading to hypertrophy of the contralateral liver lobe. At the second stage, tumor cleaning of the future liver remnant (FLR) is performed, usually by non‐anatomical partial resection. (B) Left‐first approach with portal vein ligation/embolization (PVL/PVE): The less invaded liver lobe (FLR, usually the left lobe) is cleaned of its metastases in combination with intraoperative PVL/PVE at the first stage. At the second stage, the tumor‐bearing liver lobe (deportalized liver lobe) is anatomically removed. (C) Left‐first approach followed by PVE: percutaneous PVE is performed between the first and second stages. (D) ALPPS: the less invaded liver lobe is cleaned of its metastases in combination with intraoperative PVL/PVE and in situ splitting of the hemiliver at the first stage. At the second stage, usually 7‐14 days later, the tumor‐bearing liver lobe is removed