HE ADDITION OF BEVACIZUMAB, a monoclonal antibody against vascular endothelial growth factor, to cytotoxic chemotherapy is associated with improved survival in patients with stage IV colorectal cancer and higher pathologic response rates in patients undergoing resection of colorectal liver metastases. 1,2 Response to bevacizumab, which exerts an antiangiogenic mechanism of action, may be inadequately assessed by traditional size-based radiologic criteria, the Response Evaluation Criteria in Solid Tumors (RECIST), which were designed for assessing tumor volume reduction following cytotoxic chemotherapy. [3][4][5] In support of this, a recent phase 3 trial showed that the addition of bevacizumab to oxaliplatin-based chemotherapy for metastatic colorectal cancer improved progression-free survival without affecting RECIST-defined response rates. 6 Recently, pathologic response to preoperative chemotherapy has been shown to correlate with improved sur-Author Affiliations are listed at the end of this article.

NLR independently predicts survival in patients with CLM treated with chemotherapy followed by resection or chemotherapy only. When chemotherapy normalizes high NLR, improved survival is expected.

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Background Preoperative portal vein embolization (PVE) is increasingly used as a preparation for major hepatectomy in patients with inadequate liver remnant volume or function. However, whether segment 4 (S4) portal veins should be embolized is controversial. The effect of S4 portal vein embolization on the volume gain of segments 2 and 3 (S2+3) was examined. Methods Among 73 patients with uninjured liver who underwent right PVE (RPVE, n = 15) or RPVE extended to S4 portal veins (RPVE+4, n = 58), volume changes in S2+3 and S4 after embolization were compared. Clinical outcomes and PVE complications were assessed. Results After a median of 27 days, the S2+3 volume increased significantly after both RPVE and RPVE+4, but the absolute increase was significantly higher for RPVE+4 (median, 106 ml vs. 141 ml, P = 0.044), as was the hypertrophy rate (median, 26% vs. 54%, P = 0.021). There was no significant difference between RPVE and RPVE+4 in the absolute S4 volume increase (52 ml for RPVE vs. 55 ml for RPVE+4, P = 0.61) or the hypertrophy rate of S4 (30% for RPVE vs. 26% for RPVE+4, P = 0.45). Complications of PVE occurred in 1 patient (7%) after RPVE and 6 (10%) after RPVE+4 (P > 0.99). No PVE complication precluded subsequent resection. Curative hepatectomy was performed in 13 patients (87%) after RPVE and 40 (69%) after RPVE+4 (P = 0.21). Conclusions RPVE+4 significantly improves S2+3 hypertrophy compared to RPVE alone. Extending RPVE to S4 does not increase PVE-associated complications.

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