ALPPS surgery enhances liver regeneration by allowing one lobe to proliferate while another manages metabolic tasks.

• The fast-regenerating lobe (FRL) increases growth when the metabolic load of the non-growing lobes (LLs) is appropriately managed.
• Transcriptomics and metabolomics show distinct roles: FRL focuses on growth while LLs handle metabolic support.

Surgeons can tailor surgical strategies based on metabolic capacity to optimize outcomes during ALPPS procedures.

• Reduced ligated volume enhances FRL growth by increasing metabolic activity in LLs, indicating a potential strategy for improving patient selection.