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Digestive Disease Interventions 2017; 01(03): 171-183
DOI: 10.1055/s-0037-1606204
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Portal Vein Embolization in the Treatment of Metastatic Colorectal Cancer: Optimal Approach and Current Controversies

Daniel Gans
1   Division of Vascular and Interventional Radiology, Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Christopher Siegel
2   Division of Hepatobiliary and Transplant Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Indravadan J. Patel
1   Division of Vascular and Interventional Radiology, Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Sidhartha Tavri
1   Division of Vascular and Interventional Radiology, Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
,
David C. Madoff
3   Division of Interventional Radiology, Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
,
Christopher Sutter
1   Division of Vascular and Interventional Radiology, Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

24 May 2017

08 June 2017

Publication Date:
03 August 2017 (online)

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Abstract

Colorectal carcinoma metastatic to the liver is associated with increased morbidity and mortality. Many therapies targeting liver metastasis have been associated with prolonged life and palliation, but few are more effective than surgical resection. Preoperative portal vein embolization (PVE) can facilitate contralateral hepatic lobe hypertrophy, and allow for subsequent surgical resection of metastatic disease in patients whose postoperative residual liver volume is considered marginal or too small to support proper liver function. A thorough preprocedural workup is necessary, including proper multidisciplinary patient selection, imaging, and liver volume measurements. PVE can be performed with multiple approaches and techniques, each with advantages and disadvantages. Both older and newer surgical alternatives exist, including portal vein ligation and the associating liver partition and portal vein ligation in staged hepatectomy strategy. The variability in embolization techniques and surgical alternatives in the treatment of patients with potentially resectable metastatic colorectal cancer in the liver naturally lends itself to controversy. We aim to discuss the workup, pathophysiology, technical details, and outcomes of PVE, as well as surgical alternatives and current controversies.

Keywords

portal vein embolization - colorectal liver metastasis - future liver remnant - portal vein ligation - ALPPS