Published online Feb 27, 2021. doi: 10.4254/wjh.v13.i2.261
Peer-review started: November 24, 2020
First decision: January 11, 2021
Revised: January 20, 2021
Accepted: February 12, 2021
Article in press: February 12, 2021
Published online: February 27, 2021
Two-stage hepatectomy (TSH) is a well-established surgical technique, used to treat bilateral colorectal liver metastases (CRLM) with a small future liver remnant (FLR). However, in classical TSH, drop-out is reported to be around 25%-40%, due to insufficient FLR increase or progression of disease. Trans-arterial radioembolization (TARE) has been described to control locally tumor growth of liver malignancies such as hepatocellular carcinoma, but it has been also reported to induce a certain degree of contralateral liver hypertrophy, even if at a lower rate compared to portal vein embolization or ligation.
Herein we report the case of a 75-year-old female patient, where TSH and TARE were combined to treat bilateral CRLM. According to computed tomography (CT)-scan, the patient had a hepatic lesion in segment VI-VII and two other confluent lesions in segment II-III. Therefore, one-stage posterior right sectionectomy plus left lateral sectionectomy (LLS) was planned. The liver volumetry estimated a FLR of 38% (segments I-IV-V-VIII). However, due to a more than initially planned, extended right resection, simultaneous LLS was not performed and the patient underwent selective TARE to segments II-III after the first surgery. The CT-scan performed after TARE showed a reduction of the treated lesion and a FLR increase of 55%. Carcinoembryonic antigen and CA 19.9 decreased significantly. Nearly three months later after the first surgery, LLS was performed and the patient was discharged without any postoperative complications.
According to this specific experience, TARE was used to induce liver hypertrophy and simultaneously control cancer progression in TSH settings for bilateral CRLM.
Core Tip: Two-stage hepatectomy and trans-arterial radioembolization (TARE) are usually used in advanced stage primary liver malignancies. In this case report, two-stage hepatectomy and TARE were combined, for the first time, to treat a patient with bilateral colorectal liver metastases and a small future liver remnant. In particular, TARE was performed to induce liver hypertrophy and at the same time to control tumor growth between stages, thus reducing the risk of tumor progression.