Evaluating Liver Hypertrophy Techniques: LVD vs. vALPPS in Staged Hepatectomy

New comparative data in patients with a small future liver remnant (FLR) undergoing staged hepatectomy contrast Liver Venous Deprivation (LVD) and vALPPS, revealing trade-offs that alter resection planning.

vALPPS shows the fastest regeneration: median time-to-resection for vALPPS variants was approximately 28.5 days versus roughly 47.5 days for LVD. Reported sFLR values rose from near 28% pre‑hypertrophy to about 40% post‑hypertrophy. vALPPS produced the shortest interval to completion hepatectomy and achieved comparable absolute post‑hypertrophy FLR percentages, shortening oncologic wait times for resection in patients with aggressive tumors.

Safety outcomes shaped the comparison in a retrospective, two‑referral‑center cohort of 84 patients who completed the staged approach (21.1% drop‑out rate). Overall differences were modest, but subgroup analysis was informative: in the colorectal liver metastasis (CRLM) subgroup, Liver Venous Deprivation was associated with fewer major complications and no reported 90‑day mortality, while vALPPS variants delivered faster early hypertrophy at the cost of greater procedural intensity. In this series, LVD therefore showed a favorable safety profile for higher‑risk patients.

Operationally, the choice is a familiar clinical trade‑off between speed and perioperative risk. Tumor biology, patient frailty, and institutional experience and resources should guide individual selection, favoring vALPPS when minimizing time‑to‑resection is critical and LVD when short‑term morbidity must be minimized.

Key Takeaways:

• vALPPS achieves faster hypertrophy and shorter time‑to‑resection (~28.5 days) but involves greater procedural intensity.
• Liver Venous Deprivation demonstrated fewer major complications and no 90‑day mortality in the reported CRLM subgroup, favoring safety in higher‑risk patients.
• Technique selection should be individualized by tumor biology, patient fitness, and center resources and decided in multidisciplinary review.