Radiofrequency ablation resulting in left lobe hypertrophy and improved resectability

Area of Science:

• Hepatobiliary surgery
• Interventional radiology
• Oncology

Background:

• Surgical resection of colorectal liver metastases requires adequate functional liver remnant volume.
• Portal venous embolization, chemotherapy, and radiofrequency ablation (RFA) are options for inoperable lesions.

Observation:

• A 73-year-old patient with liver metastases underwent surgery for right hemi-hepatectomy.
• Intraoperative findings revealed unexpected involvement of right and middle hepatic veins, precluding resection.
• Radiofrequency ablation (RFA) was performed due to insufficient residual volume.

Findings:

• Follow-up imaging showed lesion atrophy and significant left lateral lobe hypertrophy.
• This hypertrophy enabled a successful hemi-hepatectomy.
• Intra-hepatic portal vein thrombosis, a known RFA complication, appeared beneficial in this case.

Implications:

• Suggests reassessment of unresectable liver disease by liver surgeons is crucial.
• The case may inform new approaches to portal embolization techniques.
• Highlights the potential for unexpected benefits from interventional radiology procedures in liver surgery planning.