Expanding Resectability in Bilobar Colorectal Liver Metastases: Hepatic Venous Deprivation as Part of Contemporary Staged Hepatectomy

Bilobar colorectal liver metastases (CRLM) remain one of the most challenging scenarios in hepatobiliary surgery because complete oncologic resection often requires removal of extensive hepatic parenchyma while preserving an adequate future liver remnant (FLR). Over the past two decades, advances in systemic chemotherapy, minimally invasive liver surgery, liver-directed interventions, and multidisciplinary treatment planning have substantially expanded resectability, allowing an increasing number of patients previously considered unresectable to undergo curative-intent surgery. Contemporary management now focuses on selecting among complementary strategies that safely maximize resectability while preserving functional liver reserve. Within this evolving treatment algorithm, hepatic venous deprivation (HVD) has emerged as an important strategy for FLR augmentation in appropriately selected patients requiring major hepatectomy. As functional assessment of the FLR continues to evolve beyond volumetric measurements alone, appropriate patient selection and individualized operative planning have become increasingly important. This case-based review describes the successful management of a 66-year-old woman with bilobar CRLM treated with neoadjuvant chemotherapy, robotic first-stage parenchymal-sparing liver resection combined with synchronous sigmoid colectomy, HVD, and completion open extended right hepatectomy after adequate FLR hypertrophy. Using this case as a framework, we review the contemporary management of bilobar CRLM, current approaches to FLR augmentation, the rationale for selecting HVD over alternative strategies, evolving methods of functional liver assessment, and the role of minimally invasive staged hepatectomy within multidisciplinary oncological care. This case illustrates the feasibility of integrating HVD with systemic therapy, parenchymal-sparing surgery, and staged hepatectomy in a carefully selected patient with extensive bilobar CRLM. However, further comparative evidence and longer oncologic follow-up are required to define the optimal role of HVD relative to established FLR augmentation strategies.