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Open Access Case report

Sequential preoperative hepatic vein embolization after portal vein embolization for extended left hepatectomy in colorectal liver metastases

Gitonga Munene1, Robyn D Parker2, John Larrigan3, Jason Wong3, Francis Sutherland2 and Elijah Dixon2*

Author Affiliations

1 Department of General Surgery, University of Tennessee Health Center, 1325 Eastmoreland Avenue, Suite 140, Memphis, TN 38104-7540, USA

2 Department of Surgery and Surgical Oncology, University of Calgary, Foothills Medical Center, 1403, 29th Street NW, Calgary, AB T2N 2T9, Canada

3 Department of Interventional Radiology, University of Calgary, Foothills Medical Center, 1403, 29th Street NW, Calgary, AB T2N 2T9, Canada

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World Journal of Surgical Oncology 2013, 11:134  doi:10.1186/1477-7819-11-134

Published: 11 June 2013

Abstract

Background

The role of portal vein embolization to increase future liver remnant (FLR) is well-established in the treatment of colorectal liver metastases. However, the role of hepatic vein embolization is unclear.

Case report

A patient with colorectal liver metastases received neoadjuvant chemotherapy prior to attempted resection. At the time of resection his tumor appeared to invade the left and middle hepatic vein, requiring an extended left hepatectomy including segments five and eight. Post-operatively, he underwent sequential left portal vein embolization followed by left hepatic vein embolization and finally, middle hepatic vein embolization. Hepatic vein embolization was performed to increase the FLR as well as to allow collateral drainage of the FLR to develop. A left trisectionectomy was then performed and no evidence of postoperative liver congestion or morbidity was found.

Conclusion

Sequential portal vein embolization and hepatic vein embolization for extended left hepatectomy may be considered to increase FLR and may prevent right hepatic congestion after sacrificing the middle vein.

Keywords:
Colorectal liver metastases; Hepatic vein embolization; Hepatectomy