Colorectal carcinoma metastatic to the liver is associated with increased morbidity and mortality. Many therapies targeting liver metastasis have been associated with prolonged life and palliation, but few are more effective than surgical resection. Preoperative portal vein embolization (PVE) can facilitate contralateral hepatic lobe hypertrophy, and allow for subsequent surgical resection of metastatic disease in patients whose postoperative residual liver volume is considered marginal or too small to support proper liver function. A thorough preprocedural workup is necessary, including proper multidisciplinary patient selection, imaging, and liver volume measurements. PVE can be performed with multiple approaches and techniques, each with advantages and disadvantages. Both older and newer surgical alternatives exist, including portal vein ligation and the associating liver partition and portal vein ligation in staged hepatectomy strategy. The variability in embolization techniques and surgical alternatives in the treatment of patients with potentially resectable metastatic colorectal cancer in the liver naturally lends itself to controversy. We aim to discuss the workup, pathophysiology, technical details, and outcomes of PVE, as well as surgical alternatives and current controversies.

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sensitivities correlate with drainage outcomes and complications and can inform long-term management decisions.

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