ReviewChirurgie (Heidelberg, Germany)2026
[Conditioning and systemic treatment before extensive liver resection].
Review in Chirurgie (Heidelberg, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
5 authors.
Funding
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Abstract
backgroundPosthepatectomy liver failure (PHLF) remains the leading cause of morbidity and mortality following major liver resection. The preoperative conditioning of the future liver remnant (FLR) is therefore essential to optimize the resectability and avoid postoperative complications.
objectiveThe aim of this review article is the presentation and critical evaluation of current strategies for liver conditioning, including interventional, surgical and systemic strategies. MATERIAL AND
methodsA selective literature search for databases was conducted in PubMed. The focus was on recent systematic reviews, randomized trials and registry analyses addressing portal vein embolization (PVE), liver venous deprivation (LVD), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), selective internal radiation therapy (SIRT) and neoadjuvant chemotherapy.
resultsThe PVE procedure has been the established standard for decades, with proven safety and reliable induction of hypertrophy but shows limitations due to insufficient growth or tumor progression in up to 20% of patients. In numerous studies the LVD procedure demonstrated a more rapid and extensive hypertrophy of the FLR compared with PVE, without compromising safety. The ALPPS provides the highest regeneration dynamics but is associated with high morbidity and mortality and requires strict patient selection. The SIRT (radiation lobectomy) enables both tumor control and a relevant compensatory hypertrophy, even though prospective comparative trials are lacking. Neoadjuvant chemotherapy, particularly FOLFOXIRI plus bevacizumab or biomarker-based treatment regimen selection, leads to high conversion and resection rates in initially nonresectable metastases. DISCUSSION: The current evidence shows that individualized strategies for liver conditioning are decisive to enable a safe resection. The selection of the procedure should be oriented to the patient characteristics, tumor biology and interdisciplinary treatment algorithms.
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