Impact of portal vein embolisation uses in colorectal liver metastases: evidence from a rapid review.

OBJECTIVES

To compare the short- and long-term outcomes of patients with colorectal liver metastases (CRLM) who underwent portal vein embolisation followed by liver resection (PVEfLR) with those who underwent other treatment strategies.

DESIGN

Rapid review of the literature retrieved through a systematic search.

DATA SOURCES: Electronic databases PubMed, Embase and Ovid MEDLINE were searched from 1 April 2014 to 31 December 2025.

ELIGIBILITY CRITERIA: Studies were included if they involved only patients with CRLM, applied PVEfLR and reported comparative outcomes against other interventions (eg, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), liver transplantation and portal vein ligation). Only randomised controlled trials, cohort and case-control studies published in English were included. Studies that included patients other than those with CRLM were excluded.

DATA EXTRACTION AND SYNTHESIS: Two authors independently screened records, extracted data and assessed quality using the Newcastle-Ottawa Scale. Data were narratively synthesised and presented in summary tables.

RESULTS

14 studies (n=2,022 patients) were included. The overall median survival time for the PVEfLR group was similar to that of the ALPPS group but significantly lower than that of the liver transplantation group (19 vs 41 months, p=0.007). Postoperative complications were significantly lower for PVEfLR than for ALPPS (27% vs 65%, p<0.05) but higher than for liver resection without portal vein embolisation (51% vs 36%, p<0.001). The future liver remnant growth and completion rates for PVEfLR were variable compared with those of other techniques.

CONCLUSIONS

PVEfLR is an effective strategy for converting selected patients with initially unresectable CRLM to resectable status, achieving long-term survival comparable to other complex techniques such as ALPPS, although with a different perioperative risk profile. The choice of technique should be individualised based on the patient's anatomy, disease burden and institutional expertise.