Portal vein occlusion before major hepatectomy in patients with colorectal liver metastases: Rationale, indications, technical aspects, complications and outcome

VEGF levels and the angiogenic potential of the microenvironment can affect surgical strategy for colorectal liver metastasis

“…In specific anatomic cases, portal vein embolization is performed to increase the volume of the non-embolized liver. 3 However, this stimulation of liver growth may also favor metastasis in the remnant liver. For this reason, chemotherapy is continued during the interval between embolization and surgery.…”

Granulomatous Phlebitis of the Hepatic Vein Tributaries after Portal Venous Embolization

“…So far, granulomatous phlebitis of the hepatic veins has not been described in the surgically resected livers with PVE [8][9][10][11]. The reasons why such phlebitis has not been described or reported, may be oversight of the lesion because this lesion is more or less subtle in H&E stained sections or because in embolized livers, the portal venous emboli with inflammation might have overshadowed this hepatic venous lesion.…”

“…PVE has become a widely accepted practice before major hepatectomy [8][9][10][11]. The embolized liver part(s), in which liver tumor(s) were located, became atrophic and the non-embolized liver parts hypertrophic.…”

“…Although some complications such as hematoma [8][9][10][11] were reported in relation with PVE, there has been no report of granulomatous phlebitis of the hepatic vein after PVE. Recently, we experienced granulomatous phlebitis in surgically resected liver after PVE for metastatic liver tumor.…”

Treatment of Hepatocellular Carcinoma

“…In the field of colorectal hepatic metastases, preoperative portal vein embolization can be undertaken when the future remnant liver is expected to be insufficient [57]. However, the hypertrophy response on a cirrhotic liver seems reduced [58,59] and the procedure itself may promote metastatic growth of dormant micrometastases [60].…”