title: Portal vein embolization effect on colorectal cancer liver metastasis progression: Lessons learned.
abstract: Colorectal liver metastasis (CRLM) is the major cause of death in patients diagnosed with colorectal cancer. The gold standard treatment of CRLM is surgical resection. Yet, in the past, more than half of these patients were deemed unresectable due to the inadequate future liver remnant (FLR). The introduction of efficient portal vein embolization (PVE) preoperatively allowed more resections of metastasis in CRLM patients by stimulating adequate liver hypertrophy. However, several experimental and clinical studies reported tumor progression after PVE which critically influences the subsequent management of these patients. The underlying pathophysiological mechanism of tumor progression post-PVE is still not fully understood. In spite of the adverse effects of PVE, it remains a potentially curative procedure in patients who would remain otherwise unresectable because of the insufficient FLR. Currently, the challenge is to halt tumor proliferation following PVE in patients who require this technique. This could potentially be achieved by either attempting to suppress the underlying oncologic stimulus or by inhibiting tumor growth once observed after PVE, without jeopardizing liver regeneration. More research is still required to better identify patients at risk of experiencing tumor growth post-PVE.
authors.affiliation: Eman Al-Sharif, Mazen Hassanain, Department of Surgery, College of Medicine, King Saud University, Riyadh 11466, Saudi Arabia.
authors.forename: Eman
authors.initials: E
authors.lastname: Al-Sharif
authors.affiliation: Eman Al-Sharif, Mazen Hassanain, Department of Surgery, College of Medicine, King Saud University, Riyadh 11466, Saudi Arabia.
authors.forename: Eve
authors.initials: E
authors.lastname: Simoneau
authors.affiliation: Eman Al-Sharif, Mazen Hassanain, Department of Surgery, College of Medicine, King Saud University, Riyadh 11466, Saudi Arabia.
authors.forename: Mazen
authors.initials: M
authors.lastname: Hassanain
keywords: Colorectal liver metastases; Future liver remnant; Liver hypertrophy; Liver resection; Portal vein embolization; Prevention; Tumor growth