Figure 4.

Algorithm of patient with HCC and cirrhosis/fibrosis treated with ALPPS. Conventional ALPPS stage-1 (liver partition and portal vein ligation) is performed to induce hypertrophy of FLR. Two weeks later, with insufficient induction in FLR volume, TAE of arteries supplying the tumor is performed to induce FLR hypertrophy, and finally followed by tumor resection (conventional ALPPS stage-2). The whole procedure is referred to as TAE-salvaged ALPPS. With adequate increase in FLR volume by conventional ALPPS stage-1, the conventional ALPPS stage-2 can be directly applied to complete the conventional ALPPS. HCC, hepatocellular carcinoma; ALPPS, associating liver partition and portal vein ligation for staged hepatectomy; FLR, future liver remnant; TAE, transcatheter arterial embolization.