Skip to main content

Advertisement

Log in

Chemotherapy-associated liver injury: Does it really matter?

  • Published:
Current Colorectal Cancer Reports

Abstract

Modern oncosurgical strategies are producing dramatic response rates and remarkable long-term survival rates for patients with hepatic colorectal cancer metastases. However, the increasing delivery of preoperative systemic chemotherapy to patients has coincided with recognition of possible chemotherapy-associated injury to the nontumoral liver. Although multiple groups have described gross changes in the appearance of the liver following systemic chemotherapy, the exact histopathologic lesions have not been clearly defined. A review of the literature on the topic indicates that host factors (eg, diabetes mellitus, obesity) may be as responsible for the development of liver injury as the drugs delivered. With a lack of published evidence indicating that chemotherapy-associated liver injury results in adverse outcomes, several groups have recently questioned the clinical significance of this entity. Relatively few studies have been able to link chemotherapy-associated liver injury with adverse post-hepatectomy outcomes. This article describes the current understanding of this topic and seeks to answer the question of whether chemotherapy-associated liver injury actually impacts outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Fernandez FG, Drebin JA, Linehan DC, et al.: Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg 2004, 240:438–447.

    Article  PubMed  Google Scholar 

  2. Abdalla EK, Vauthey JN, Ellis LM, et al.: Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004, 239:818–825.

    Article  PubMed  Google Scholar 

  3. Choti MA, Sitzmann JV, Tiburi MF, et al.: Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 2002, 235:759–766.

    Article  PubMed  Google Scholar 

  4. Pawlik TM, Scoggins CR, Zorzi D, et al.: Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 2005, 241:715–722.

    Article  PubMed  Google Scholar 

  5. Bilchik AJ, Poston G, Curley SA, et al.: Neoadjuvant chemotherapy for metastatic colon cancer: a cautionary note. J Clin Oncol 2005, 23:9073–9078. [Published erratum appears in J Clin Oncol 2006, 24: 1648.]

    Article  PubMed  CAS  Google Scholar 

  6. Parikh AA, Gentner B, Wu TT, et al.: Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy. J Gastrointest Surg 2003, 7:1082–1088.

    Article  PubMed  Google Scholar 

  7. Kooby DA, Fong Y, Suriawinata A, et al.: Impact of steatosis on perioperative outcome following hepatic resection. J Gastrointest Surg 2003, 7:1034–1044.

    Article  PubMed  Google Scholar 

  8. Rubbia-Brandt L, Audard V, Sartoretti P, et al.: Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol 2004, 15:460–466.

    Article  PubMed  CAS  Google Scholar 

  9. Aloia T, Sebagh M, Plasse M, et al.: Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases. J Clin Oncol 2006, 24:4983–4990.

    Article  PubMed  CAS  Google Scholar 

  10. Vauthey JN, Pawlik TM, Ribero D, et al.: Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 2006, 24:2065–2072.

    Article  PubMed  CAS  Google Scholar 

  11. Nordlinger B, Sorbye H, Glimelius B, et al.: Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet 2008, 371:1007–1016.

    Article  PubMed  CAS  Google Scholar 

  12. Adam R, Delvart V, Pascal G, et al.: Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 2004, 240:644–657.

    Article  PubMed  Google Scholar 

  13. Rubbia-Brandt L, Mentha G, Terris B: Sinusoidal obstruction syndrome is a major feature of hepatic lesions associated with oxaliplatin neoadjuvant chemotherapy for liver colorectal metastases. J Am Coll Surg 2006, 202:199–200.

    Article  PubMed  Google Scholar 

  14. Fernandez FG, Ritter J, Goodwin JW, et al.: Effect of steatohepatitis associated with irinotecan or oxaliplatin pretreatment on resectability of hepatic colorectal metastases. J Am Coll Surg 2005, 200:845–853.

    Article  PubMed  Google Scholar 

  15. DeLeve LD, Shulman HM, McDonald GB: Toxic injury to hepatic sinusoids: sinusoidal obstruction syndrome (venoocclusive disease). Semin Liver Dis 2002, 22:27–42.

    Article  PubMed  Google Scholar 

  16. Kandutsch S, Klinger M, Hacker S, et al.: Patterns of hepatotoxicity after chemotherapy for colorectal cancer liver metastases. Eur J Surg Oncol 2008, 34:1231–1236.

    PubMed  CAS  Google Scholar 

  17. Karoui M, Penna C, Amin-Hashem M, et al.: Influence of preoperative chemotherapy on the risk of major heaptectomy for colorectal liver metastases. Ann Surg 2006, 243:1–7.

    Article  PubMed  Google Scholar 

  18. Sebagh M, Plasse M, Levi F, Adam R: Severe hepatic sinusoidal obstruction and oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer: a real entity? Ann Oncol 2005, 16:331.

    Article  PubMed  CAS  Google Scholar 

  19. Vuppalanchi R, Chalasani N: Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: selected practical issues in their evaluation and management. Hepatology 2009, 49:306–317.

    Article  PubMed  Google Scholar 

  20. Sahajpal A, Vollmer CM Jr, Dixon E, et al.: Chemotherapy for colorectal cancer prior to liver resection for colorectal cancer hepatic metastases does not adversely affect perioperative outcomes. J Surg Oncol 2007, 95:22–27.

    Article  PubMed  CAS  Google Scholar 

  21. Pawlik TM, Olino K, Gleisner AL, et al.: Preoperative chemotherapy for colorectal liver metastases: impact on hepatic histology and postoperative outcome. J Gastrointest Surg 2007, 11:860–868.

    Article  PubMed  Google Scholar 

  22. Ribero D, Wang H, Donadon M, et al.: Bevacizumab improves pathologic response and protects against hepatic injury in patients treated with oxaliplatin-based chemotherapy for colorectal liver metastases. Cancer 2007, 110:2761–2767.

    Article  PubMed  Google Scholar 

  23. Kesmodel SB, Ellis LM, Lin E, et al.: Preoperative bevacizumab does not significantly increase postoperative complication rates in patients undergoing hepatic surgery for colorectal cancer liver metastases. J Clin Oncol 2008, 26:5254–5260.

    Article  PubMed  Google Scholar 

  24. Peppercorn PD, Reznek RH, Wilson P, et al.: Demonstration of hepatic steatosis by computerized tomography in patients receiving 5-fluorouracil-based therapy for advanced colorectal cancer. Br J Cancer 1998, 77:2008–2011.

    PubMed  CAS  Google Scholar 

  25. Oliva MR, Mortele KJ, Segatto E, et al.: Computed tomography features of nonalcoholic steatohepatitis with histopathologic correlation. J Comput Assist Tomogr 2006, 30:37–43.

    Article  PubMed  Google Scholar 

  26. Kleiner DE, Brunt EM, Van Natta M, et al.: Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005, 41:1313–1321.

    Article  PubMed  Google Scholar 

  27. Fong Y, Bentrem DJ: CASH (Chemotherapy-Associated Steatohepatitis) costs. Ann Surg 2006, 243:8–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas A. Aloia.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aloia, T.A., Fahy, B.N. Chemotherapy-associated liver injury: Does it really matter?. Curr colorectal cancer rep 5, 108–113 (2009). https://doi.org/10.1007/s11888-009-0016-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11888-009-0016-7

Keywords

Navigation