Approach to the management of bilobar colorectal liver metastases

(A) Example of extensive bilobar colorectal liver metastases, with two lesions in the left lobe (orange) and five lesions in the right lobe (green). The operative plan is ultimately to perform a right hepatectomy, but currently there is inadequate future liver remnant.
(B,C) The future liver remnant is cleared with partial hepatectomies of the two lesions on the left (dotted circles).
(D,E) The right portal vein is embolized to increase the future liver remnant on the left.
(F) After an adequate increase in the future liver remnant, a formal anatomic resection of the right lobe can be performed. Finally, all of the bilobar colorectal liver metastases are removed and adequate future liver remnant maintained.