title: The significance of portal vein embolization  in the treatment of colorectal liver metastases.
abstract: The first aim of the present paper was to evaluate hypertrophy of liver parenchyma after portal vein embolization in patients after systemic chemotherapy for colorectal carcinoma metastases and planned extensive liver resections. The second aim was to study whether hypertrophy of the liver parenchyma remnant after could influence the postoperative course large liver resections in long-term chemotherapy within complex therapy of colorectal carcinoma.The prospective study comprised of 43 patients with colorectal hepatic metastases in whom liver resections of 4-5 segments were planned (Table 1). All patients underwent complex therapy of colorectal carcinoma, including chemotherapy consisting of 6-12 therapeutic cycles. Time interval between chemotherapy and liver resection was 2-24 months (mean interval of 8 months). Twenty patients whose presumed liver parenchyma remnant was less than 40% of total liver volume were indicated for portal vein embolization (mean liver parenchyma remnant of 29%). This was always embolization of the right portal branch. Twenty-three patients were primarily indicated to liver resection.
  
  
  RESULTS
  Hypertrophy of the left liver lobe occurred in all 20 patients. After portal vein embolization, the volume of left liver increased on average from 476 ml (282-754) to 584 ml (380-892) (P < 0.05). Mean hypertrophy of left liver lobe after portal vein embolization was 28.5%. The measured parenchyma remnant after tumor resection increased from 29% up to 38% by hypertrophy. Mean values of ALT and AST in the postoperative period were significantly different in the groups in this study. The values of alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GMT) were lower in patients after portal vein embolization (P < 0.05). Significant differences were in postoperative level of serum bilirubin, bilirubin levels in patients after portal vein embolization were 2-3 times lower than in the group of patients after immediate surgery (P < 0.05). he values of prothrombin time were also significantly lower in patients who underwent surgery without previous portal vein embolization (P < 0.05).
authors.affiliation: First Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc.
authors.forename: P
authors.initials: P
authors.lastname: Zboril
authors.forename: K
authors.initials: K
authors.lastname: Vyslouzil
authors.forename: I
authors.initials: I
authors.lastname: Klementa
authors.forename: P
authors.initials: P
authors.lastname: Skalicky
authors.forename: K
authors.initials: K
authors.lastname: Vomackova
authors.forename: M
authors.initials: M
authors.lastname: Cerna
authors.forename: K
authors.initials: K
authors.lastname: Cwiertka
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000209:etiology / Q000628:therapy*; D008113:Liver Neoplasms / Q000150:complications / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D000410:Alanine Transaminase; D001663:Bilirubin