[Resection for multiple metastatic liver tumors after preoperative portal embolization]

Surgical resection has been recognized as the most effective treatment for patients with colorectal liver metastases. However, hepatectomy can be performed in only approximately 10% to 20%. Among the factors that are contraindications for hepatectomy, insufficient functional volume of the remnant liver after hepatic resection can cause postoperative hepatic failure and is still an obstacle to major hepatic resection. As one of the solutions to this dilemma and to be able to expand the indications for major hepatectomy, preoperative portal embolization (PVE) was proposed to induce compensatory hypertrophy of the contralateral remnant liver in patients with metastatic disease as well as in those with injured hepatic parenchyma, i.e., hepatocellular carcinoma and hilar cholangiocarcinoma. Currently, PVE allows more patients with previously unresectable liver tumors to benefit from resection. Long-term survival is comparable to that after resection without PVE.