Treatment of liver metastases from colorectal cancers. Role of Interventional Radiology in complex hepatectomies.

In the case of exclusive or predominant colorectal metastatic liver involvement, multimodal treatment, initially medical with a central decisive surgical procedure, is a major prognostic factor. To undergo surgery, the patient must have at least 30% of liver remaining immediately after surgery, this percentage increasing with age and the potential alteration of hepatocellular function by neoadjuvant treatments. Thus, for these patients who have routinely received hepatotoxic treatments, a future liver remnant (FLR) of at least 40-45% is required, which rarely occurs spontaneously. Several interventional radiology techniques make it possible to prepare for surgery in these patients by increasing the FLR volume through percutaneous embolization of the portal venous system of the liver to be resected (PVE). This procedure is technically feasible in nearly 100% of cases with low morbidity and an increase in FLR within 4 weeks. allowing the surgical procedure in nearly 80% of cases. During the procedure, one or two hepatic veins can also be embolized, thereby creating liver venous deprivation (LVD), inducing faster and greater growth of the FLR without additional morbidity. Finally, lobar neoadjuvant selective radioembolization (SIRT) can also be performed, allowing control of the tumor disease and an increase in the FLR within a few months through contralateral radiation-induced hepatitis.