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Different strategies have been used to induce preoperative liver hypertrophy and reduce the risk of postoperative liver failure. Those have included both radiological-interventional and surgical strategies, such as portal and hepatic vein embolization, 2-stage hepatectomy and associated liver partition with portal vein ligation for staged hepatectomy (ALPPS). Herein, we describe the case of a patient with a large right liver hepatocellular carcinoma not amenable to liver transplantation, with HBV-related chronic hepatitis and a small future liver remnant (FLR), who underwent a multistep approach to ensure a safe major laparoscopic resection with an adequate FLR.

From PVE to HVE to fully laparoscopic rescue ALPPS: a case report of multidisciplinary management of giant HCC