Surgical resection has been recognized as the most effective treatment for patients presenting colorectal liver metastases (CLM). However, major right hepatectomy cant be applied if the volume of the future remnant liver (FRL) is less than 30% of the total liver volume because of high risk of postoperative hepatic failure. Portal vein embolization (PVE), by inducing significant hypertrophy of thenonembolized liver in a short delay, allows to perform a major hepatectomy in patients initially considered unresectable for volumetric reasons.Two-stage hepatectomy combined with PVE has been...

From February 1996 to February 2002, 47 patients underwent portal vein embolization before major right hepatectomy forcolorectal liver metastasesin our institution. Among these patients 2 groups can be considered : - Two-stage hepatectomy group (Group A) : 20 patients presenting bilobar liver metastases inwhom a first hepatectomy was initially performed in order to clear the future remnant liver and then followed by percutaneous PVE. Second-stage hepatectomywasattempted after sufficient hypertrophy of the healthy parenchyma.- One stage hepatectomy group (GroupB) : 27 patients presenting right unilobar metastases...

First-stage hepatectomy (group A) :The number of resected metastases from the left liver (or lobe) before portal embolization ranged from 1 to 3 nodules (mean 1,3). The mean size of tumours was 20 +/- 4 mm. Mean interval time between first hepatectomy and PVE was 14 +/- 3 days. Type of resection (table).Type of embolization: Embolization was limited to the right portal branch in 80% of patients in group A and 85% in group B. Associated embolization of right portal branch and segment IV was...

Portal vein embolization combined with two-stage hepatectomy offers nearly the same results as conventional technique using PVE and single hepatectomy in terms of liver hypertophy and survival rate of operated patients. This procedure allows to propose carcinologic surgical resection to patients presenting multiple bilobar colorectal liver metastases initially considered unresectable.

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To contact the authors :Michel GREGET (MD)Service de Radiologie I Hpital de HautepierreHpitaux Universitaires de STRASBOURG67098 STRASBOURG [email protected]