Presenter: Filipe Kunzler MD | Miami Cancer Institute Background: The prognosis of metastatic colon cancer has markedly improved over the last decades thanks to a multidisciplinary approach that has allowed more patients to reach surgical resection. For patients with severe tumoral burden and inadequate functional liver remnant volumes, however, the prognosis is still guarded. The purpose of this abstract is to report on the application of a triple unified-modality for parenchymal hypertrophy (TRIUMPH). This includes transarterial radioembolization (TARE), portal vein embolization (PVE) and hepatic vein embolization (HVE), which simultaneously provides local tumor control and induces contralateral liver hypertrophy. Methods: All patients initially considered not to be candidates for surgery due to an extremely small liver remnant that underwent venous deprivation between March and August 2020 were included. Results: Four patients were identified. The median age was of 59 years at surgery (45-66) and they received 7.5 cycles of chemotherapy (7-16). The time between diagnosis and TARE was of 140.5 days (87.5-199.75), between TARE and PVE of 30.5 days (26.25-91), between PVE and HVE of 1 days (1-74.25), and between the HVE to surgery of 72.5 days (63.25-89.75). Three patients received TARE to segment IV, and three PVE to segment IV. All patients underwent right HVE, and three also to the middle HVE (Figure 1). The functional liver remnant (segments 1, 2 and 3) underwent a relative growth of 100.9 ± 28.4% (mean ± SD), with a kinetic rate of 3.3 ± 1.7% per week, with an increase in the FLR to 971.5 ± 457ml. All patients underwent successful open extended right hepatectomies with median estimated blood loss of 200ml (range 100-200), length of stay of 4 days (3-5), and no severe complications (Median Clavien-Dindo of 0, [0-2]). Pathological response was partial in two patients and near complete and complete in the other two. All margins were free of tumor. Conclusion: This is a promising minimally invasive approach to induce maximal parenchymal hypertrophy in patients deemed unresectable due to extensive liver metastasis and ultimately provide them with a chance for surgical cure. On the last decade, Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS) has been performed with this objective. Even though multiple series have reported it to be successful in causing liver remnant hypertrophy, this approach is known to have high morbidity. TRIUMPH seems to be safe and it holds the advantage of providing local tumor control and contralateral liver hypertrophy in a minimally invasive fashion. The review of these four cases shows the feasibility of what the authors call TRIUMPH in rescuing patients with extensive liver metastasis that were otherwise deemed unresectable. A larger series is needed to confirm these findings.