Comparing hypertrophy of the future liver remnant for two different strategies of portal vein embolization in patients with bilobar colorectal liver metastases - a retrospective European multicentre study

Dennis Björk; Tim Reese; Anne M Holmen Longva; Kristian S Kiim; Maximilian Evers; Peter N Larsen; Nicolai Aagaard Schultz; Bård I Røsok; Ulrik Carling; Fredrik Holmquist; Gert Lindell; Per Sandström; Jörg Böcker; Stefan Gilg; Jennie Engstrand; Christian Sturesson; Karl J Oldhafer; Ernesto Sparrelid; Bergthor Björnsson

doi:10.1016/j.hpb.2025.12.006

Comparing hypertrophy of the future liver remnant for two different strategies of portal vein embolization in patients with bilobar colorectal liver metastases - a retrospective European multicentre study

HPB (Oxford). 2025 Dec 3:S1365-182X(25)01722-8. doi: 10.1016/j.hpb.2025.12.006. Online ahead of print.

Authors

Dennis Björk¹, Tim Reese², Anne M Holmen Longva³, Kristian S Kiim⁴, Maximilian Evers⁵, Peter N Larsen⁴, Nicolai Aagaard Schultz⁴, Bård I Røsok³, Ulrik Carling⁵, Fredrik Holmquist⁶, Gert Lindell⁶, Per Sandström⁷, Jörg Böcker⁸, Stefan Gilg², Jennie Engstrand², Christian Sturesson², Karl J Oldhafer⁸, Ernesto Sparrelid², Bergthor Björnsson⁷

Affiliations

¹ Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. Electronic address: dennis.bjork@liu.se.
² Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
³ Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.
⁴ Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Denmark.
⁵ Department of Radiology, Rigshospitalet, Oslo University Hospital, Oslo, Norway.
⁶ Department of Surgery, Skåne University Hospital, Lund, Sweden.
⁷ Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
⁸ Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.

PMID: 41419351
DOI: 10.1016/j.hpb.2025.12.006

Abstract

Background: Portal vein embolization (PVE) is a well-established technique for inducing liver hypertrophy in the future liver remnant (FLR) before major hepatectomy. A frequently used method in bilobar disease is the two-stage hepatectomy (TSH) technique combined with PVE (TSH-PVE). A novel approach is PVE, followed by a one-stage hepatectomy (OSH), combining major hepatectomy with clearing of the FLR (PVE-OSH). This study aimed to compare FLR hypertrophy between these two strategies for induced liver hypertrophy.

Material/methods: Patients with bilobar colorectal liver metastases (CRLM) who underwent PVE from January 2013 to December 2021 were included in this retrospective, multicenter study. Aspects of hypertrophy of the FLR were compared between the groups.

Results: The study included 188 patients, 127 in the PVE-OSH group and 61 in the TSH-PVE group. There were no statistically significant differences between the two groups regarding FLR hypertrophy measured by absolute and relative growth, degree of hypertrophy or kinetic growth rate. No major complications were reported.

Discussion/conclusion: No differences in FLR hypertrophy were demonstrated between the two different treatment strategies of TSH-PVE or PVE-OSH. This supports PVE-OSH as a feasible treatment option that reduces the surgical burden for patients with advanced, bilobar CRLM disease.