Chemotherapy does not impair hypertrophy of the left liver after right portal vein obstruction

Abstract

In patients with multiple colorectal liver metastases, the technical limits of curative surgery can be overcome by both reducing tumor volume with preoperative chemotherapy and by increasing the future remnant liver with portal vein embolization. Chemotherapy is generally discontinued before the embolization because it is alleged to impair hypertrophy of the future remnant liver. We have tested this assumption by comparing two groups of patients who had undergone right portal vein obstruction: 10 patients in whom chemotherapy was maintained until surgery and 10 patients in whom it was interrupted at least 1 month prior to portal obstruction. The two groups, with and without chemotherapy, were comparable for patient's age (60 +/- 9 versus 61 +/- 9 years), number of metastases (7.7 +/- 3 versus 6.2 +/- 3), and future remnant liver volume (25 +/- 9% versus 23 +/- 5% of the total liver). After right portal vein obstruction, the increase of the future remnant liver was comparable in the two groups (33 +/- 26% versus 25 +/- 7%). Liver resection was performed in 14 patients (7 in each group) with a similar morbidity rate (57% in each group). In conclusion, continuing chemotherapy while portal vein obstruction is performed did not impair the hypertrophy of the future remnant volume nor the postoperative course after liver resection. Therefore, chemotherapy can be safely continued until liver surgery, when portal vein obstruction is indicated.