Sequential Preoperative Ipsilateral Portal and Arterial Embolization in Patients with Liver Tumors: Is It Really the Best Approach?

Excerpt

We published an article [1] in the World Journal of Surgery in April 2006 reporting our initial experience with the sequential preoperative right portal (RPVE) and right hepatic artery embolization (RHAE) in patients with colorectal hepatic metastases. The article reported our initial approach to this strategy, devised to deal with two potential problems that may be left unresolved by portal vein embolization: unsatisfactory hypertrophy and tumor progression while awaiting hypertrophy in the nonembolized liver. This strategy for treating metastatic colorectal cancer in patients with otherwise healthy livers had never been reported in the English literature, although it had been previously described by a Japanese group in two cases of treatment for cholangiocarcinoma in the presence of markedly impaired functional hepatic reserve [2]. Both reports focused on the possibility of extending the indication for liver resection in cases not otherwise amenable to surgical treatment because of the small remnant and the high risk of postoperative, postresection liver failure. …