RAPID procedure in patients with cirrhosis with or without hepatocellular cancer: a brief selection of candidates and a detailed description of the techniques.

Abstract

The RAPID technique, i.e., Resection And Partial Liver Transplantation With Delayed Total Hepatectomy, represents one of the latest advancements in the field, recently discussed at the Zurich consensus meeting of the ISLS (International Society of Liver Surgeons).RAPID can be applied in the setting of either liver metastases developed on normal liver or of cirrhosis with or without hepatocellular carcinoma (HCC). RAPID for cirrhosis represents a stepwise evolution however, two main characteristics distinguish the RAPID technique in healthy liver from RAPID for cirrhosis: first, the functional reserve of the native cirrhotic liver is limited that is difficult to accurately estimate preoperatively, and second, existing portal hypertension (PHT) related to the cirrhosis complicates parenchymal transection and may also injure the implanted small graft. In this paper, we will describe the selection of the best candidates and the RAPID technique for cirrhosis. The measurement and modulation modalities of the portal flow will be particularly addressed.