title: [Multimodal approach to rectal carcinoma with hepatic metastasis].
abstract: BACKGROUND
  The role of surgery in the treatment of rectal cancer has been demonstrated worldwide. Moreover, curative liver resection of colorectal liver metastases is the only treatment offering a chance of long-term survival. Unfortunately, the liver resection can be performed in only 10% of the patients.
  
  
  OBJECTIVE
  In order to extend the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer, we describe, in the video, a multimodal approach to rectal cancer with liver metastasis in the right lobe. Patient and methods. A 51 years old woman was admitted to our Department for adenocarcinoma of the distal rectum and a resectable solitary synchronous liver metastasis located across the right and the middle hepatic vein. Unfortunately, the future remnant liver was too small, risking severe post-operative liver failure. For this reason, a portal vein embolization or occlusion has been proposed. First of all, the patient has been submitted to laparoscopic low anterior resection with simultaneous right portal vein ligature. Two months later, after a CT estimation of liver volume in vivo, she was submitted to right hepatectomy (open surgery).
  
  
  RESULTS
  Both postoperative courses were uneventful.
  
  
  CONCLUSIONS
  As a preparation for large hepatic resection for liver rectal metastasis the laparoscopic ligature of the right portal vein performed simultaneously to the laparoscopic low anterior resection is feasible and safe.
authors.affiliation: Dipartimento Assistenziale di Scienze Chirurgiche, Università Vita-Salute, Istituto Scientifico Universitario San Raffaele, Milano.
authors.forename: E
authors.initials: E
authors.lastname: Orsenigo
authors.forename: L
authors.initials: L
authors.lastname: Aldrighetti
authors.forename: C
authors.initials: C
authors.lastname: Pulitanò
authors.forename: G
authors.initials: G
authors.lastname: Bissolotti
authors.forename: P
authors.initials: P
authors.lastname: Bisagni
authors.forename: C
authors.initials: C
authors.lastname: Staudacher
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008026:Ligation; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology* / Q000628:therapy*