Background: Although portal vein embolization (PVE) and staged hepatectomy (StHx), as well as prehepatectomy chemotherapy, have improved the resectability rate of patients with multiple bilobar colorectal liver metastases, the impact of prehepatectomy chemotherapy on liver hypertrophy following PVE and/or StHx has remained unclear.
Methods: Sixty patients who underwent PVE followed by one-stage hepatectomy and StHx with or without PVE were analyzed. Liver hypertrophy following PVE and/or the first hepatectomy of StHx and the clinical course after final hepatectomy was compared between patients with and without prehepatectomy chemotherapy.
Results: No difference of volume of the future liver remnant (FLR) before or after the procedure was seen between the chemotherapy group and the nonchemotherapy group. Even in 38 patients who underwent right PVE prior to a planned right hemihepatectomy, the chemotherapy group (n = 14) and the nonchemotherapy group (n = 24) were comparable in terms of volumes of FLR before (P = 0.71) and after (P = 0.29) PVE and posthepatectomy courses. However, the liver hypertrophy ratio for patients showing steatosis in adjacent nonmalignant liver parenchyma, which frequently is induced by chemotherapy, was lower than that for patients without steatosis (P = 0.04).
Conclusions: Although prehepatectomy chemotherapy did not impair liver hypertrophy, PVE and/or StHx accompanied by prehepatectomy chemotherapy should be performed with particular care to minimize risk of liver failure after the procedure.