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

## TL;DR

This study shows that one-stage liver surgery after portal embolization can safely treat both sides of the liver with metastases, avoiding the need for a second operation.

## Contribution

The study presents a one-stage hepatectomy approach for bilateral liver metastases after portal embolization, challenging the traditional two-stage method.

## Key findings

- The median future liver remnant increased from 20.4% to 31.5% after portal vein embolization.
- Contralateral metastasis diameter decreased or remained stable in 73.3% of patients.
- R0 resection was achieved in 80% of patients with no early mortality.

## 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 hepatectomy in 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 FLR pre- 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.