Affiliation:
1. From the Departments of Surgical Oncology, Pathology, and Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Pathology; Massachusetts General Hospital, Boston, MA; and Departments of Pathology and Surgical Oncology, Istituto per la Ricerca e la Cura del Cancro, Torino, Italy.
Abstract
PurposeChemotherapy before resection of hepatic colorectal metastases (CRM) may cause hepatic injury and affect postoperative outcome.Patients and MethodsFour hundred six patients underwent hepatic resection of CRM between 1992 and 2005. Pathologic review of the nontumorous liver was performed using established criteria for steatosis, steatohepatitis, and sinusoidal injury. The effect of chemotherapy and liver injury on perioperative outcome was analyzed.ResultsOne hundred fifty-eight patients (38.9%) received no preoperative chemotherapy, whereas 248 patients (61.1%) did. The median duration of chemotherapy was 16 weeks (range, 2 to 70 weeks). Chemotherapy consisted of fluoropyrimidine-based regimens (fluorouracil [FU] alone, 15.5%; irinotecan plus FU, 23.1%; and oxaliplatin plus FU, 19.5%) and other therapy (3.0%). On pathologic analysis, 36 patients (8.9%) had steatosis, 34 (8.4%) had steatohepatitis, and 22 (5.4%) had sinusoidal dilation. Oxaliplatin was associated with sinusoidal dilation compared with no chemotherapy (18.9% v 1.9%, respectively; P < .001; odds ratio [OR] = 8.3; 95% CI, 2.9 to 23.6). In contrast, irinotecan was associated with steatohepatitis compared with no chemotherapy (20.2% v 4.4%, respectively; P < .001; OR = 5.4; 95% CI, 2.2 to 13.5). Patients with steatohepatitis had an increased 90-day mortality compared with patients who did not have steatohepatitis (14.7% v 1.6%, respectively; P = .001; OR = 10.5; 95% CI, 2.0 to 36.4).ConclusionSteatohepatitis is associated with an increased 90-day mortality after hepatic surgery. In patients with hepatic CRM, the chemotherapy regimen should be carefully considered because the risk of hepatotoxicity is significant.
Publisher
American Society of Clinical Oncology (ASCO)
Reference47 articles.
1. Recurrence and Outcomes Following Hepatic Resection, Radiofrequency Ablation, and Combined Resection/Ablation for Colorectal Liver Metastases
2. Trends in Long-Term Survival Following Liver Resection for Hepatic Colorectal Metastases
3. Five-Year Survival After Resection of Hepatic Metastases From Colorectal Cancer in Patients Screened by Positron Emission Tomography With F-18 Fluorodeoxyglucose (FDG-PET)
4. Effect of Surgical Margin Status on Survival and Site of Recurrence After Hepatic Resection for Colorectal Metastases
5. Kemeny NE, Kemeny MM, Lawrence TS: Liver metastases, in Abeloff MD, Armitage JO, Lichter AS, et al (eds): Clinical Oncology . New York, NY, Churchill Livingstone, pp 886,2000-921
Cited by
1123 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献