Future remnant liver

Curative resection of liver metastases is mainly performed in patients presenting with colorectal primary cancer. Liver metastases are found in 40%-70% of patients with a colorectal cancer. In about one third of cases, the liver is shown to be the only site of cancer spread, even at autopsy. There is no spontaneous long-term survival in untreated patients, whose median survival time range from 6 to 18 months. Furthermore, liver involvement is the most important factor associated with decreased patient survival. However, at time of diagnosis, the majority of patients present unresectable tumors, and resection can be performed in <20% of all patients with colorectal liver metastases. The main limitation for resectahility is the impossibility to be curative while leaving a sufficient residual amount of functional liver parenchyma. Consequently, preoperative PVE may dramatically improve the possibilities for a curative (RO) resection of liver metastases by increasing the volume and the function of the future remnant liver. 

Another possible area of investigation includes the prophylactic radioemboiization of remnant liver tissue in patients undergoing hepatic resection for HCC or colorectal metastases. Although initially attractive, this approach may hinder and limit the ability for future Y to the prophylactically radio-embolized lobe. Furthermore, the blood supply to small metastases is derived from the portal vein, not the hepatic artery, bringing into question whether prophylactic treatment would yield any radiation effect to microscopic metastases [59]. Therefore, if such a study is undertaken, since imaging of micro-metastases is not possible, improved survival or decreased time to disease recurrence would represent possible endpoints. It is clear that further research is needed to address possible treatment options for advanced stage HCC. Any studies in this patient population require careful consideration of the risk of therapy induced liver failure vs. the benefit of lesion stabilization. 

Broering DC, Hillert C, Krupski G et al. (2002) Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the future liver remnant. J Gastrointest Surg 6 905-913... 

Vauthey JN, Chaoui A, Do KA, Bilimoria MM, Fensterma-cher MJ, Charnsangavej C, Hicks M, Alsfasser G, Lauw-ers G, Hawkins IF, Caridi J (2000) Standardized measurement of the future liver remnant prior to extended liver resection methodology and clinical associations. Surgery 127 512-519... 

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