Portal vein occlusion before major hepatectomy in patients with colorectal liver metastases: rationale, indications, technical aspects, complications and outcome.

Surgery is the only curative treatment for colorectal liver metastases (CRLM), but resection should be total with tumor-free margins and the remaining parenchyma, functionally evaluated. The rationale behind portal vein embolization (PVE) to reduce the risk of these hepatic resections is threefold: (i) surgery for CRLM has become more and more aggressive, and hepatocellular insufficiency represents the leading cause of mortality after major hepatectomy for hepatic metastasis (HM), (ii) underlying hepatic disease occurs more frequently than previously thought in these patients having undergone neoadjuvant chemotherapy, and can alter hepatic function and/or hinder postoperative regeneration, and (iii) the operative risk is increased if major hepatectomy is associated with resection of the primary tumor. The goal of this update is to review the reasons behind and the indications for PVE, to analyze the literature pertaining to whether PVE should be routine or selective, and to tackle certain technical aspects, all within the framework of the treatment of CRLM.