• Catha Fischer, Laleh G Melstrom, Dean Arnaoutakis, William Jarnagin, Karen Brown, Michael D'Angelica, Anne Covey, Ronald DeMatteo, Peter Allen, T Peter Kingham, Scott Tuorto, Nancy Kemeny, and Yuman Fong.
• Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
• JAMA Surg. 2013 Dec 1;148(12):1103-8.

ImportancePortal vein embolization improves the safety of liver resection by increasing the size of residual liver, but the embolization may increase tumor growth during the waiting period before definitive hepatectomy.ObjectiveTo determine whether the administration of chemotherapy mitigates tumor growth after portal vein embolization (PVE) performed before major hepatectomy for metastatic colorectal cancer.Design, Setting, And ParticipantsReview of prospectively collected data at Memorial-Sloan Kettering Cancer Center was conducted. The database included patients subjected to PVE before major hepatectomy for metastatic colorectal cancer.Main Outcomes And MeasuresLesions in both the embolized and nonembolized lobes of the liver before and 1 month after PVE were measured and Response Evaluation Criteria in Solid Tumors were applied to assess disease status. Assessment of survival was based on receipt of post-PVE chemotherapy and then stratified by subsequent resectability.ResultsTwo hundred eight tumors were measured in 64 patients; 53 tumors were in patients undergoing post-PVE chemotherapy. Approximately one-third of the lesions progressed after PVE when no chemotherapy was administered. This did not differ significantly according to whether tumors were ipsilateral or contralateral to the PVE. When chemotherapy was administered, there was a significantly lower rate of progression (18.9%, P = .03). In long-term follow-up, treatment with post-PVE chemotherapy was also independently associated with improved survival (P < .006).Conclusions And RelevanceChemotherapy does not retard growth of the liver after PVE and may prevent cancer progression. Thus, the combination of PVE and chemotherapy may enhance both oncologic and operative safety.

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