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A common strategy to induce pre-operative FLR hypertrophy is portal vein embolization of the tumor bearing liver lobe. More recently, transarterial radio-embolization (radiation lobectomy, RL) has been employed. Direct functional assessment using 99mTc-mebrofenin-hepatobiliary-scintigraphy (HBS) predicts FLR sufficiency more accurately than conventional volume assessment. However, studies describing dynamic functional assessment of the FLR after RL as induction for surgery are currently lacking. This study aims to compare FLR functional changes after PVE and RL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This non-interventional retrospective single-center cohort study was performed between 2016 and 2024. Patients with colorectal liver metastases (CRLM) who underwent PVE or RL because of an insufficient FLR (HBS\u2009&lt;\u20092.7%\/min\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) were included. Induction of sufficient FLR function was the primary outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ten PVE- and ten RL-treated patients were included. The median duration to achieve sufficient FLR function was longer for RL- than PVE-treated patients (75 days (64\u201385) vs 31 days (28\u201354.5),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). RL showed a non-significant higher median functional increase (58.6% vs 51.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.940) and a significantly higher voluminal increase (65.7% vs 36.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.049) compared to PVE. PHLF and resection margins were comparable among groups. There was no 90\u2009day mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>RL represents a feasible alternative to PVE with comparable functional outcomes, particularly in patients with lower baseline FLR function or need for simultaneous tumor control. This warrants prospective studies with optimized RL protocols to better define the functional outcomes and clinical applications of RL versus PVE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10456-026-10049-5","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T16:38:28Z","timestamp":1779295108000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Portal vein embolization versus radiation lobectomy as pre-treatment for major liver resection for colorectal liver metastases: functional assessment of the future liver remnant"],"prefix":"10.1007","volume":"29","author":[{"given":"Khalil","family":"Ramdhani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalie C. 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RCMVR, DA and RCGB have nothing to disclose. MGEHL has acted as a consultant for Boston Scientific, Terumo, Becton and Dickinson, Oncosil, NRG Pallas and Novartis, and receives research support from Novartis, Boston Scientific and Terumo. AJATB acts as consultant for Boston Scientific, Terumo, GEHealthcare, Telix Pharmaceuticals; receives research support from Boston Scientific, Terumo, GE Healthcare, Ariceum Therapeutics, Telix Pharmaceuticals and Siemens. MLJS has acted as consultant for Terumo, Medtronic and Philips. The UMC Utrecht has received research support and royalties from Terumo and Quiremspheres.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. Need for informed consent was waived by the institutional medical ethics committee for this retrospective cohort study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"34"}}