A 60-year-old man was admitted to our institution having a descending colon cancer with synchronous liver metastases. Tumor marker levels were remarkably elevated and the liver metastases were multiple and located at both right lobe and segment 4. Due to lack of the remnant liver volume, left hemicolectomy and intraoperative right portal vein branch embolization were performed as a primary operation. Three weeks after the operation, he started to undergo systemic chemotherapy by mFOLFOX6. After 8 courses of the treatment, grade 3 neurotoxicity appeared, and we changed the regimen to FOLFIRI. During a total of 18 courses of the chemotherapy, the periodic CT scans revealed the liver metastases to be PR or SD, and no other metastatic lesion was detected. After the rest of chemotherapy for 7 weeks, extended right hepatectomy was performed. He had an uneventful postoperative course and the tumor marker levels immediately returned to normal levels. He has been in good health without a recurrence for 10 months after hepatectomy. The combination of portal vein embolization and systemic chemotherapy may contribute to improve respectability of synchronous multiple and bilobar colorectal liver metastases.
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