Effect and Mechanism of ALPPS Operation on Liver Regeneration

Inclusion Criteria: 1. Age: Patients aged 18 to 75 years 2. Diagnosis established: A diagnosis of hepatobiliary malignancy (including hepatocellular carcinoma and cholangiocarcinoma) was confirmed and evaluated as suitable for ALPPS surgery 3. Liver function status: preoperative Child-Pugh score A or B, MELD score ≤15, with sufficient liver function reserve for operation 4. Tumor characteristics: bilobal or complex tumors of the liver with large tumor areas requiring ALPPS to ensure adequate residual liver volume (FLR/TLV\<30% or FLR/BW\<0.5) 5. Preoperative assessment: Imaging showed that future liver residual (FLR) was insufficient to support standard hepatectomy, and liver volume must be increased by ALPPS 6. FLR enlargement: Postoperative assessment of FLR enlargement as expected (at least 30% enlargement or FLR/BW above 0.5) for a second procedure 7. No distant metastases: No unresectable extrahepatic metastases, except for resectable lung metastases Exclusion Criteria: 1. Preoperative FLR insufficiency: Residual liver volume (FLR) did not increase sufficiently after the first step (\<30% increase or FLR/BW \<0.5) to be suitable for the second step 2. Extrahepatic metastasis: unresectable distant metastasis, such as extensive metastasis of bone, lung, etc 3. Severe liver disease: very poor liver function before surgery, Child-Pugh grade C or severe liver sclerosis during surgery (e.g. Metavir≥F3 or 30% or more hepatic steatosis) 4. Major comorbidities: Major illnesses such as severe cardiovascular disease, kidney failure, or respiratory failure that do not tolerate major surgery 5. Postoperative complications: Serious postoperative complications (such as liver failure, infection, etc.) after the first step are not suitable for the second step 6. Evaluation of adverse surgery: After the first procedure, FLR blood supply or function is abnormal, affecting liver regeneration 7. Pregnancy and lactation: pregnant or lactating women