One-Stage Hepatectomy for Bilateral Liver Metastasis After Portal Embolization - Tumor Behavior of the Non-embolized Contralateral Lobe

Sep 30, 2026

Alternative to the classic two-stage hepatectomy for bilobar colorectal liver metastases, this study evaluates performing portal vein embolization (PVE) to enable continuing chemotherapy while pursuing a one-stage liver resection. A non-concurrent cohort design included patients undergoing PVE before resection for bilobar metastases, assessing baseline factors, post-PVE volumetry, changes in metastasis diameter within the future liver remnant, perioperative variables, and overall survival. Among 15 patients, most showed metastasis stability or decrease after PVE, enabling R0 resection in 80% without early mortality.

LanguageEnglish

CategoryHealthcare

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Reading Time20 min

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Abstract

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Materials And Methods

Review began 04/01/2025 Review ended 07/01/2025 Published 12/09/2025 © Copyright 2025 Riveros et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98786 Open Access Original Article One-Stage Hepatectomy for Bilateral Liver Metastasis After Portal Embolization: Tumor Behavior of the Non-embolized Contralateral Lobe Sergio Riveros 1 , Maria Irarrazaval 1 , Antonio Peñailillo 2, Joaquin Hevia 2 , Pablo Achurra 3, Nicolás Jarufe 4, Jorge Martínez 4, Luis Meneses 2, Martín Dib 4, 5 1. Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, CHL 2. Department of Interventional Radiology, Pontificia Universidad Católica de Chile, Santiago, CHL 3. Department of Hepatobiliary Surgery, Hospital Clínico Universidad Católica, Santiago, CHL 4. Department of Hepatobiliary and Pancreatic Surgery, Pontificia Universidad Católica de Chile, Santiago, CHL 5. Division of Transplantation, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA Corresponding author: Martín Dib, [dibmartin@gmail.com](dibmartin@gmail.com) Abstract Background Two-stage hepatectomy is a well-known strategy for bilobar liver metastases,“cleaning” the future liver remnant (FLR) in the first stage, using portal vein embolization (PVE), and performing a major hepatectomyin the second stage. We used an alternative approach, performing PVE, to continue chemotherapy and perform liver resection. We describe our experience emphasizing liver hypertrophy and the tumor behavior of the contralateral liver metastasis. Methods Non-concurrent cohort study. Patients who underwent PVE before liver resection for bilobar metastases were included. Pre-PVE variables, post-PVE volumetry, variation of metastasis diameter in the FLR, perioperative variables, and overall survival were evaluated. Results Fifteen patients were included. Neoadjuvant chemotherapy was given in 14 patients (93 .3%) . Median FLRpre-and post-PVE were 20.4% and 31 .5% . The median degree of hypertrophy was 46.2% . Median kinetic growth rate was 1.9% per week. The metastasis diameter decreased or was maintained in 11 patients (73 .3%) after PVE. Twelve (80%) underwent R0 resection. Major postoperative morbidity occurred in two patients (13 .3%); no early mortality was reported. Conclusions One-stage hepatectomy after PVE effectively achieves an adequate FLR, with contralateral tumor growth absent in most cases. This allows the continuation of chemotherapy during the hypertrophy period and achieves R0 resection of bilobar metastasis. Categories: General Surgery, Oncology, Gastroenterology Keywords: bilobar metastasis, contralateral tumor, kgr, liver hypertrophy, portal vein embolization, pve, remnant tumor behavior Introduction The gold standard treatment for resectable colorectal liver metastases (CRLM) is surgical resection, as recommended in the latest National Comprehensive Cancer Network (NCCN) Guidelines (2024) and other guidelines [1] . Nevertheless, only 15%-20% of the patients with CRLM are candidates for surgical resection due to an insufficient future liver remnant (FLR) . This situation increases the risk of postoperative hepatic dysfunction, overall morbidity, and mortality [2] . Portal vein embolization (PVE) is an alternative for stimulating hypertrophy of the FLR before major hepatic resections [1] . This procedure was first described in 1982 by Makuuchi et al. [3] and has been refined overtime. PVE is frequently performed in patients with primary liver/biliary cancer and liver metastases, mainly from colorectal neoplasms [1,4] . It induces hypertrophy on one side of the parenchyma before a planned hepatic resection of the other side of the liver. It simultaneously beco

FAQs

What alternative strategy does the study evaluate for bilobar liver metastases?

The study evaluates a one-stage hepatectomy approach after portal vein embolization (PVE), aiming to continue chemotherapy during liver hypertrophy rather than using the classic two-stage “cleaning” strategy.

What outcomes were analyzed after PVE?

Evaluations included pre-PVE variables, post-PVE volumetry, changes in metastasis diameter within the future liver remnant, perioperative variables, and overall survival.

What did the study find regarding tumor behavior in the contralateral liver lobe?

After PVE, metastasis diameter decreased or was maintained in 11 of 15 patients (73.3%), and R0 resection was achieved in 80% of patients.

Sep 30, 2026

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