Current strategies to induce liver remnant hypertrophy before major liver resection

Table 1 Indication, advantages, and disadvantages of existing approaches to induce liver remnant hypertrophy before major liver resection

Approach	Indication	Advantage	Disadvantage
PVE	Insufficient FLR volume	Percutaneous approach	Contraindicated in patients with extensive portal thrombus and important portal hypertension; Could promote tumoral growth within the embolized liver
PVL and two-stage hepatectomy	Insufficient FLR volume and treatment of bilobar liver disease	PVL is performed during the first surgical step (tumoral clearance of the FLR)	Surgical procedure; Morbidity
Associating liver partition and PVL for staged hepatectomy	Insufficient FLR volume +/- treatment of bilobar liver disease	Liver surgery is performed in a short period of time (15 d); First surgical step (PVL and in situ splitting of the liver parenchyma) can be associated with tumoral clearance of the FLR	Surgical procedure; Morbidity
Sequential trans arterial embolization and PVE	Insufficient FLR volume in patients with hepatocellular carcinoma	Percutaneous approachMay help to counteract the stimulating effect of PVE on tumor growth	Sequential approach (two procedures) is recommended to limit the risk of nontumoral liver ischemic necrosis; Contraindicated in patients with extensive portal thrombus, important portal hypertension or previous biliary surgery (biliodigestive anastomosis)
Liver venous deprivation	Insufficient FLR volume	Percutaneous approach	Contraindicated in patients with extensive portal thrombus and important portal hypertension; Could promote tumoral growth within the embolized liver
RL	Insufficient FLR volume	Percutaneous approachConcomitant tumoral control and FLR increaseCan be carried out in patients with portal vein thrombosis	Data reporting liver resection after RL is scarce

PVE: Portal vein embolization; FLR: Future liver remnant; PVL: Portal vein ligation; RL: Radiation lobectomy.