Right portal vein ligation prior to extended right hemihepatectomy for synchronous colorectal liver metastases

Introduction. A two-step procedure is suggested to reduce the overall operative risk in patients with colorectal cancer and large synchronous liver metastases, which demand an extended right hernihepatectomy for RO resection. Methods. The clinical course and volumetric evaluation of the liver is described in three patients in whom preliminary ligation of the right branch of the portal vein was performed at the time of colon resection. Results. The size of the left lateral lobes increased by 9.9%,13.7%, and 4.9% of total liver volume, respectively. At the same time, the noninfiltrated part of the right lobes shrunk by 36.7%,36%, and 6% whereas metastatic growth was 26.8%,22.3%, and 12%. After 7 weeks, extended right hemihepatectomy could be performed in all three patients without signs of hepatic insufficiency, yielding RO resection. Conclusion. Preliminary portal venous ligation can reduce the risk for extended right hernihepatectomy in selected patients with synchronous colorectal liver metastases.