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10.1245/s10434-008-9925-y
Annals of Surgical Oncology 15:1908-1917 (2008)
© 2008 Society of Surgical Oncology
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Original Article

Major Hepatectomy for Colorectal Metastases: Is Preoperative Portal Occlusion an Oncological Risk Factor?

L. Mueller, MD1,2, C. Hillert, MD1, L. Möller, MD1, G. Krupski-Berdien, PhD3,4, X. Rogiers, PhD5 and D. C. Broering, PhD2

1 Department of Hepato-Biliary Surgery and Solid Organ Transplantation, University Hospital Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
2 Department of General and Thoracic Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 7, 24105 Kiel, Germany
3 Department of Radiology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
4 Department of Diagnostic Radiology, St. Adolf-Stift Hospital Reinbek, Hamburger Str. 41, 21465 Reinbek, Germany
5 Department of General Surgery, Gent University Hospital and Medical School, De Pintelaan 185 - 2K12 1C, 9000 Gent, Belgium

Correspondence: Address correspondence and reprint requests to: L. Mueller, MD; E-mail: lars.mueller{at}uksh-kiel.de

Background: This study investigates oncological risks and benefits of portal occlusion (PO) in major resection for colorectal liver metastases (CLM).

Methods: Between 1995 and 2004, 107 patients were scheduled for major hepatectomy for CLM. Of these, 53 patients were selected for PO due to insufficient future liver remnant (FLR), and 54 patients had straightforward hepatectomy. Associations of clinicopathologic factors with resectability, and outcome after PO were analyzed.

Results: 21 of 53 patients (39.6%) after PO were unresectable. These patients had a significant smaller volume of the FLR than the 32 resected patients after PO (P = .029). In total, 17 patients (80.9%) did not undergo resection due to cancer progression. Among these, 11 patients (52.4%) exhibited either a progression of known metastases located in the occluded lobes, or new metastases in the nonoccluded portion of the liver. In another 4 individuals (19%), the decision against resection resulted from insufficient hypertrophy of the FLR. Following major hepatectomy, the 5-year survival was 43.66%. Although there was a significantly higher rate of extended hepatectomies versus formal hepatectomies (P < .001), more bilobar distributed metastases versus unilobar manifestations (P = .015), and a smaller resection margin (P = .01) in patients who had PO, no adverse effect on mortality, morbidity, recurrence and survival was observed.

Conclusion: Unresectability after PO is a major problem that warrants multidisciplinary improvements, and randomization to resection with or without PO remains ethically problematic. However, following adequate patient selection, PO may provide a significant survival benefit for patients with prior unresectable CLM.

Key Words: Liver metastasis • Portal vein embolization • Portal ligation • Hepatic resection • Complication rate






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