Chemotherapy and its effect on liver hypertrophy: implications for portal vein embolization and resection.

Liver resection remains the gold standard treatment for colorectal liver metastases (CRLM). The improvement of the efficacy of chemotherapy has resulted in an increase of CRLM candidates for curative resection, including a significant proposition of patients initially deemed unresectable. The safety of liver resection has increased by taking advantage of regenerative capacities of the liver with preoperative portal vein embolization (PVE) and two-stage strategies. However, chemotherapy regimens including new drugs such as oxaliplatin and irinotecan may induce pathologic changes of the nontumorous liver parenchyma that could increase the risk of liver resection, and the impact of chemotherapy on the nontumorous liver parenchyma may limit tolerance of these resections. Preoperative portal obstruction, including PVE, which aimed to hypertrophy the future remnant liver, can be adversely affected by this chemotherapy. The aim of this article is to describe the impact of chemotherapy on nontumorous liver parenchyma and to evaluate the impact of chemotherapy on the regenerative capacities of the liver, especially after PVE.