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Invited Critique |

Portal Vein Ligation as an Efficient Method of Increasing the Future Liver Remnant Volume in the Surgical Treatment of Colorectal Metastases—Invited Critique

Kevin G. Billingsley, MD
Arch Surg. 2008;143(10):982. doi:10.1001/archsurg.143.10.982.
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One of the most important technical developments in hepatic surgery is the use of portal venous interruption to maximize the size and function of the liver remnant. Capussotti and colleagues offer a retrospective comparison of 2 approaches to portal venous interruption. They demonstrate that a similar increase in remnant size occurs with surgical PVL vs percutaneous PVE. Both methods were safe, and both methods produced hypertrophy of the anatomic left liver.

Is there an optimal approach to portal venous interruption? Like most technical approaches in liver surgery, the details of the technique must be tailored to the specifics of the clinical situation. One concern that drives decision making is the potential for liver regeneration induced by portal venous interruption to enhance tumor growth in the remnant.1,2 As such, patients with disease in the planned remnant are ideal for a staged approach in which the disease in the planned remnant is resected and the portal vein is ligated. A later definitive resection is performed after hypertrophy.3

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