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Portal vein ligation is just as effective as portal vein embolization in increasing the size of a liver that is to undergo partial resection for colorectal metastases, according to a report.

Portal vein ligation is just as effective as portal vein embolization in increasing the size of a liver that is to undergo partial resection for colorectal metastases, according to a report in the October issue of the Archives of Surgery.

Preoperative chemotherapy combined with larger hepatic resections improves survival for patients with liver metastases from colorectal cancer. However, with these treatments, the remaining functional liver is relatively small, which increases the risk of postoperative hepatic insufficiency and other complications.

With portal vein embolization or portal vein ligation, the portal branches feeding the liver to be resected are blocked, which increases the size of the future liver remnant volume and, as a result, reduces the risk of postoperative complications. There has been some evidence to suggest that portal vein ligation may not be as effective as portal vein embolization in this regard.

To examine this further, Dr. Andrea Muratore, from Istituto per la Ricerca e la Cura del Cancro in Torino, Italy, and colleagues compared liver segment volumes in 17 patients treated with portal vein ligation and 31 treated with portal vein embolization prior to undergoing a major hepatic resection. In 16 of the portal vein ligation patients, the procedure was associated with removal of a synchronous colorectal cancer.

No deaths related to the portal vein procedure occurred in either group, the authors note.

Overall, 35 patients underwent liver resection following portal vein ligation or portal vein embolization. In the 13 remaining patients, which included six treated with portal vein ligation and seven with portal vein embolization, liver resection was not performed in most cases because CT revealed non-resectable disease progression.

Portal vein ligation and portal vein embolization were associated with volumetric increases in liver segments two and three (combined) of 43.1 per cent and 53.4 per cent, respectively (p = NS). Portal vein ligation and portal vein embolization also provided comparable increases in segment four and the caudate lobe.

"The results of the present study have clearly demonstrated that portal vein ligation is a safe and efficient method of increasing the future liver remnant volume," the authors state. "Patients with synchronous colorectal cancer and multiple, bilateral liver metastases requiring a two-stage hepatectomy are the best candidates for portal vein ligation."

Arch Surg 2008;143:978-982