ALPPS is primarily used for the treatment of metastatic liver cancer (such as those from colorectal cancer and pancreatic neuroendocrine tumor) and primary hepatobiliary carcinoma (such as hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and hilar cholangiocarcinoma) with insufficient future liver remnant (FLR). The significant advantages of ALPPS include the promotion of FLR hypertrophy by 47% to 110% approximately two weeks after the first stage surgery and a two-stage hepatectomy success rate of more than 95%. However, ALPPS has significant drawbacks: The postoperative morbidity and mortality rate were reported to be as high as 13.44% to 44% and 0 to 30%, respectively, because of two major surgeries with short intervals; ALPPS is against the “no touch” principle of tumor treatment, while some surgeons even regard it as an “all touch technique” that could increase the theoretical risk of cancer metastasis. The long-term efficacy of tumor treatment with ALPPS is still under observation, as the one-year recurrence rate is reported to be as high as 40%. With 70% of ALPPS procedures being done for metastatic liver cancer, clinical data of ALPPS application is relatively limited in the cases of primary liver and biliary tumors, such as hepatocellular carcinoma (HCC) and hilar cholangiocarcinoma, in patients with underlying conditions such as hepatitis B viral infection, liver fibrosis, and cirrhosis [1–6]. According to the data of the international ALPPS registry, D’Haese et al. compared the clinical outcomes of ALPPS in 35 cases of primary liver cancer and 225 cases of metastatic liver cancer. The results showed that the average FLR hypertrophy rate was 47% for primary liver cancer and 74% for metastatic liver cancer; the 90-day mortality rate was 31% for primary liver cancer and 7% for metastatic liver cancer. Statistically significant, these differences indicate variations in clinical efficacy between the two groups [6]. Major severe perioperative complications of ALPPS include biliary fistula, hepatic failure, and abdominal infection secondary to biliary fistula, with incidence up to 20%, 23%, and 24%, respectively. These complications mainly result from the physical partition of hepatic parenchyma during the first-stage surgery and the significant trauma from the ensuing second-stage surgery. Therefore, finding ways to reduce surgical trauma, minimize perioperative morbidity and mortality, and explore innovative solutions have been the focus of research in the field of ALPPS.