Oncological safety of portal vein embolization without prior tumour clearance in the future liver remnant followed by one-stage hepatectomy for bilateral colorectal liver metastases - Summary - MDSpire

Oncological safety of portal vein embolization without prior tumour clearance in the future liver remnant followed by one-stage hepatectomy for bilateral colorectal liver metastases

  • By

  • Tim Reese

  • Dennis Björk

  • Anne M H Longva

  • Kristian S Kiim

  • Maximilian Evers

  • Peter N Larsen

  • Nicolai A Schultz

  • Bård I Røsok

  • Ulrik Carling

  • Fredrik Holmquist

  • Gert Lindell

  • Per Sandström

  • Jörg Böcker

  • Stefan Gilg

  • Jennie Engstrand

  • Christian Sturesson

  • Karl J Oldhafer

  • Bergthor Björnsson

  • Ernesto Sparrelid

  • September 22, 2025

  • 0 min

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Objective:

To investigate the oncological safety and outcomes of upfront portal vein embolization (PVE) without prior tumor clearance, specifically comparing these outcomes with traditional two-stage procedures, followed by one-stage hepatectomy (OSH) in patients with bilateral colorectal liver metastases (CRLM).

Key Findings:
  • Successful resection rates were 89% for PVE-OSH, 79% for TSH-PVE, and 96% for ALPPS (P < 0.001).
  • ALPPS patients experienced the most rapid hypertrophy, followed by PVE-OSH patients.
  • Median time from first intervention to major resection was shorter for PVE-OSH (6 weeks, IQR 5-8) compared to TSH-PVE (9 weeks, IQR 7-13) and ALPPS (1 week, IQR 1-3) (P < 0.001).
  • Postoperative outcomes regarding liver failure, mortality, and overall survival were comparable across groups.
  • Independent risk factors for liver recurrence included the number of metastases and ALPPS.
Interpretation:

PVE-OSH can be safely performed in patients with limited tumor burden in the FLR, potentially reducing the need for more complex two-stage procedures, which may improve patient outcomes.

Limitations:
  • Retrospective design may introduce selection bias, affecting the generalizability of the results.
  • Lack of standardized protocols across participating centers may lead to variability in outcomes.
Conclusion:

PVE-OSH is a viable option for managing bilateral CRLM, offering comparable outcomes to traditional two-stage approaches while reducing surgical burden, thus presenting a significant advancement in surgical oncology.

Original Source(s)

Oncological safety of portal vein embolization without prior tumour clearance in the future liver remnant followed by one-stage hepatectomy for bilateral colorectal liver metastases

  • by Tim Reese, Dennis Björk, Anne M H Longva, Kristian S Kiim, Maximilian Evers, Peter N Larsen, Nicolai A Schultz, Bård I Røsok, Ulrik Carling, Fredrik Holmquist, Gert Lindell, Per Sandström, Jörg Böcker, Stefan Gilg, Jennie Engstrand, Christian Sturesson, Karl J Oldhafer, Bergthor Björnsson, Ernesto Sparrelid

  • September 22, 2025

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