Sequential preoperative ipsilateral portal and arterial embolization in patients with colorectal liver metastases.
BACKGROUND
Preoperative portal vein embolization (PVE) induces ipsilateral atrophy of the hepatic parenchyma to be resected, as well as contralateral compensatory hypertrophy of the residual liver. However, there are two potential problems with this technique: inadequate contralateral hypertrophy and tumor progression while waiting for the non-embolized liver to hypertrophy. We devised a strategy to deal with these two problems by performing an ipsilateral hepatic artery embolization 6 weeks after an unsatisfactory PVE in an effort to accelerate the hypertrophy of the remnant liver.


METHODS
Two patients with colorectal liver metastases underwent to this sequential preoperative treatment in order to achieve resectability of their metastatic disease.


RESULTS
Both patients successfully underwent major hepatic resection.


CONCLUSIONS
In our experience sequential ipsilateral portal vein and hepatic artery embolization extended the indications for liver resection for metastatic colorectal cancer.
Gruttadauria
Salvatore
S
University of Pittsburgh Medical Center European Medical Division, Instituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy. sgruttadauria@ismett.edu
Luca
Angelo
A
Mandala'
Lucio
L
Miraglia
Roberto
R
Gridelli
Bruno
B
D000368:Aged; D015179:Colorectal Neoplasms / Q000098:blood supply* / Q000601:surgery*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D006498:Hepatectomy; D006499:Hepatic Artery; D006801:Humans; D006984:Hypertrophy; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000098:blood supply* / Q000556:secondary* / Q000601:surgery; D008115:Liver Regeneration / Q000502:physiology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011169:Portal Vein; D014057:Tomography, X-Ray Computed