Efficacy and safety of portal vein Embolization for two-stage Hepatectomy in patients with colorectal liver metastasis

Purpose To examine the efficacy and safety of portal vein embolization (PVE) when used during two-stage hepatectomy for bilobar colorectal liver metastases (CLM). Materials and Methods PVE was performed as an adjunct to two-stage hepatectomy in 56 patients with CLM. Absolute future liver remnant (FLR) volumes, standardized FLR ratios, degree of hypertrophy (DH), and complications were analyzed. Segment II and III volumes and DH were also measured separately. All volumetric measurements were compared with a cohort of 96 patients (n = 37 right portal vein embolization [RPVE], n = 59 right portal vein embolization extended to segment IV portal veins [RPVE+4]) in whom PVE was performed before single-stage hepatectomy. Results For patients who completed RPVE during two-stage hepatectomy (n = 17 of 17), mean absolute FLR volume increased from 272.1 cm³ to 427.0 cm³ (P <.0001), mean standardized FLR ratio increased from 0.17 to 0.26 (P <.0001), and mean DH was 0.094. For patients who completed RPVE+4 during two-stage hepatectomy (n = 38 of 39), mean FLR volume increased from 288.7 cm³ to 424.8 cm ³ (P <.0001), mean standardized FLR increased from 0.18 to 0.26 (P <.0001), and mean DH was 0.083. DH of the FLR was not significantly different between two-stage hepatectomy and single-stage hepatectomy. Complications after PVE occurred in five (8.9%) patients undergoing two-stage hepatectomy. Conclusions PVE effectively and safely induced a significant DH in the FLR during two-stage hepatectomy in patients with CLM.