title: Sequential preoperative hepatic vein embolization after portal vein embolization for extended left hepatectomy in colorectal liver metastases.
abstract: BACKGROUND
  The role of portal vein embolization to increase future liver remnant (FLR) is well-established in the treatment of colorectal liver metastases. However, the role of hepatic vein embolization is unclear.
  
  
  METHODS
  A patient with colorectal liver metastases received neoadjuvant chemotherapy prior to attempted resection. At the time of resection his tumor appeared to invade the left and middle hepatic vein, requiring an extended left hepatectomy including segments five and eight. Post-operatively, he underwent sequential left portal vein embolization followed by left hepatic vein embolization and finally, middle hepatic vein embolization. Hepatic vein embolization was performed to increase the FLR as well as to allow collateral drainage of the FLR to develop. A left trisectionectomy was then performed and no evidence of postoperative liver congestion or morbidity was found.
  
  
  CONCLUSIONS
  Sequential portal vein embolization and hepatic vein embolization for extended left hepatectomy may be considered to increase FLR and may prevent right hepatic congestion after sacrificing the middle vein.
authors.affiliation: Department of General Surgery, University of Tennessee Health Center, 1325 Eastmoreland Avenue, Suite 140, Memphis, TN 38104-7540, USA.
authors.forename: Gitonga
authors.initials: G
authors.lastname: Munene
authors.forename: Robyn D
authors.initials: RD
authors.lastname: Parker
authors.forename: John
authors.initials: J
authors.lastname: Larrigan
authors.forename: Jason
authors.initials: J
authors.lastname: Wong
authors.forename: Francis
authors.initials: F
authors.lastname: Sutherland
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D005234:Fatty Liver / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006504:Hepatic Veno-Occlusive Disease / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D008115:Liver Regeneration; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011184:Postoperative Period; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult