Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2021; 13(2): 261-269
Published online Feb 27, 2021. doi: 10.4254/wjh.v13.i2.261
Two-stage hepatectomy with radioembolization for bilateral colorectal liver metastases: A case report
Matteo Serenari, Jacopo Neri, Giovanni Marasco, Cristina Larotonda, Alberta Cappelli, Matteo Ravaioli, Cristina Mosconi, Rita Golfieri, Matteo Cescon
Matteo Serenari, Matteo Ravaioli, Matteo Cescon, General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna 40138, Italy
Jacopo Neri, Giovanni Marasco, Cristina Larotonda, Matteo Ravaioli, Matteo Cescon, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
Alberta Cappelli, Cristina Mosconi, Rita Golfieri, Department of Radiology, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna 40138, Italy
Author contributions: Serenari M contributed study conception and design; Neri J, Larotonda C, Cappelli A and Mosconi C contributed acquisition of data; Marasco G contributed analysis and interpretation of data; Serenari M contributed drafting of manuscript; Golfieri R, Ravaioli M and Cescon M contributed critical revision.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Matteo Serenari, MD, Academic Research, Surgeon, General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Via Albertoni, 15, Bologna 40138, Italy.
Received: November 24, 2020
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.

Keywords: Trans-arterial, Radioembolization, Two-stage hepatectomy, Colorectal liver metastases, Selective internal radiation therapy, Yttrium90, Case report

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.