World Journal of Surgery

, Volume 38, Issue 2, pp 497–504

Influence of Preoperative Chemotherapy on CT Volumetric Liver Regeneration Following Right Hemihepatectomy

  • Simon A.W.G. Dello
  • Petra G. Serbanescu Kele
  • Robert J. Porte
  • Ronald M. van Dam
  • Joost M. Klaase
  • Cees Verhoef
  • Thomas van Gulik
  • Quintus Molenaar
  • Koop Bosscha
  • Eric J. van der Jagt
  • Cornelis H.C. Dejong
  • Marieke T. de Boer



An increasing number of patients undergo major liver resection following preoperative chemotherapy. Liver regeneration may be impaired in these patients, predisposing them to postoperative liver dysfunction. The aim of the present study was to evaluate the effects of preoperative chemotherapy on liver regeneration after partial liver resection.


Patients planned to receive right hepatectomy either with (group B) or without (group A) prior chemotherapy were identified retrospectively from a prospective multi-institutional database created in the conduct of a national randomized controlled trial (RCT). Prior chemotherapy was neither an inclusion nor an exclusion criterion of the trial. Future remnant liver volume (FRLV) was calculated by measuring total functional liver volume and resection specimen on preoperative computed tomography (CT) scans. Remnant liver volume after 7 days (VRLV7days) was measured on scheduled postoperative CT scans. The early regeneration index 7 days after surgery (RIearly) was calculated as [(VRLV7days − FRLV) / FRLV] × 100 %. Data are expressed as median (interquartile range).


A total of 72 patients were enrolled: 45 in group A and 27 in group B. For the whole group, the liver remnant showed a 58 % (39 %) increase in volume at day 7 (1) day. The RIearly was not significantly different between groups A and B, 60 % (36 %) and 50 % (43 %), respectively (p = 0.47). The RIearly was significantly lower in patients who had undergone more than six cycles of chemotherapy.


Preoperative chemotherapy does not seem to have a negative impact on early liver regeneration after partial liver resection.

Supplementary material

268_2013_2278_MOESM1_ESM.tif (596 kb)
Fig. 5a(TIF 597 kb)
268_2013_2278_MOESM2_ESM.tif (488 kb)
Fig. 5b (TIF 488 kb)
268_2013_2278_MOESM3_ESM.tif (431 kb)
Fig. 5c (TIF 432 kb)
268_2013_2278_MOESM4_ESM.tif (494 kb)
Fig. 5d (TIF 495 kb)
268_2013_2278_MOESM5_ESM.tif (790 kb)
Fig. 6a (TIF 790 kb)
268_2013_2278_MOESM6_ESM.tif (704 kb)
Fig. 6b (TIF 704 kb)
268_2013_2278_MOESM7_ESM.tif (574 kb)
Fig. 6c (TIF 575 kb)
268_2013_2278_MOESM8_ESM.doc (30 kb)
(DOC 30 kb)


  1. 1.
    Adam R, Hoti E, Bredt LC (2010) Evolution of neoadjuvant therapy for extended hepatic metastases–have we reached our (non-resectable) limit? J Surg Oncol 102(8):922–931PubMedCrossRefGoogle Scholar
  2. 2.
    Capussotti L, Muratore A, Mulas MM, Massucco P, Aglietta M (2006) Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. Br J Surg 93(8):1001–1006PubMedCrossRefGoogle Scholar
  3. 3.
    Adam R, Delvart V, Pascal G et al (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240(4):644–657 discussion 57–58PubMedGoogle Scholar
  4. 4.
    Adam R, Avisar E, Ariche A et al (2001) Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal. Ann Surg Oncol 8(4):347–353PubMedCrossRefGoogle Scholar
  5. 5.
    Nordlinger B, Sorbye H, Glimelius B et al (2008) 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 371(9617):1007–1016PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Porschen R, Arkenau HT, Kubicka S et al (2007) Phase III study of capecitabine plus oxaliplatin compared with fluorouracil and leucovorin plus oxaliplatin in metastatic colorectal cancer: a final report of the AIO Colorectal Study Group. J Clin Oncol 25(27):4217–4223PubMedCrossRefGoogle Scholar
  7. 7.
    de Gramont A, Figer A, Seymour M et al (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18(16):2938–2947PubMedGoogle Scholar
  8. 8.
    Giantonio BJ, Catalano PJ, Meropol NJ et al (2007) Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol 25(12):1539–1544PubMedCrossRefGoogle Scholar
  9. 9.
    Tol J, Koopman M, Cats A et al (2009) Chemotherapy, bevacizumab, and cetuximab in metastatic colorectal cancer. N Engl J Med 360(6):563–572PubMedCrossRefGoogle Scholar
  10. 10.
    Zorzi D, Laurent A, Pawlik TM et al (2007) Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg 94(3):274–286PubMedCrossRefGoogle Scholar
  11. 11.
    Vauthey JN, Pawlik TM, Ribero D et al (2006) Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 24(13):2065–2072PubMedCrossRefGoogle Scholar
  12. 12.
    Nakano H, Oussoultzoglou E, Rosso E et al (2008) Sinusoidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy. Ann Surg 247(1):118–124PubMedCrossRefGoogle Scholar
  13. 13.
    Peppercorn PD, Reznek RH, Wilson P, Slevin ML, Gupta RK (1998) Demonstration of hepatic steatosis by computerized tomography in patients receiving 5-fluorouracil-based therapy for advanced colorectal cancer. Br J Cancer 77(11):2008–2011PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Parikh AA, Gentner B, Wu TT et al (2003) Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy. J Gastrointest Surg 7(8):1082–1088PubMedCrossRefGoogle Scholar
  15. 15.
    Pomfret EA, Pomposelli JJ, Gordon FD et al (2003) Liver regeneration and surgical outcome in donors of right-lobe liver grafts. Transplantation 76(1):5–10PubMedCrossRefGoogle Scholar
  16. 16.
    Kele PG, de Boer M, van der Jagt EJ, Lisman T, Porte RJ (2012) Early hepatic regeneration index and completeness of regeneration at 6 months after partial hepatectomy. Br J Surg 99(8):1113–1119PubMedCrossRefGoogle Scholar
  17. 17.
    de Boer MT, Klaase JM, Verhoef C et al (2012) Fibrin sealant for prevention of resection surface-related complications after liver resection: a randomized controlled trial. Ann Surg 256(2):229–234PubMedCrossRefGoogle Scholar
  18. 18.
    Dejong C, Garden O (2003) Neoplasms of the liver. In: Majid AA, Kingsnorth A (eds) Advanced surgical practice. Greenwich Medical Media, London, pp 146–156Google Scholar
  19. 19.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213PubMedCrossRefGoogle Scholar
  20. 20.
    Zappa M, Dondero F, Sibert A et al (2009) Liver regeneration at day 7 after right hepatectomy: global and segmental volumetric analysis by using CT. Radiology 252(2):426–432PubMedGoogle Scholar
  21. 21.
    Kwon KH, Kim YW, Kim SI et al (2003) Postoperative liver regeneration and complication in live liver donor after partial hepatectomy for living donor liver transplantation. Yonsei Med J 44(6):1069–1077PubMedGoogle Scholar
  22. 22.
    Takamoto T, Hashimoto T, Sano K et al (2010) Recovery of liver function after the cessation of preoperative chemotherapy for colorectal liver metastasis. Ann Surg Oncol 17(10):2747–2755PubMedCrossRefGoogle Scholar
  23. 23.
    Dello SA, Stoot JH, van Stiphout RS et al (2011) Prospective volumetric assessment of the liver on a personal computer by nonradiologists prior to partial hepatectomy. World J Surg 35(2):386–392PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Dello SA, van Dam RM, Slangen JJ et al (2007) Liver volumetry plug and play: do it yourself with ImageJ. World J Surg 31(11):2215–2221PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Karoui M, Penna C, Amin-Hashem M et al (2006) Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 243(1):1–7PubMedCrossRefGoogle Scholar
  26. 26.
    Aussilhou B, Dokmak S, Faivre S et al (2009) Preoperative liver hypertrophy induced by portal flow occlusion before major hepatic resection for colorectal metastases can be impaired by bevacizumab. Ann Surg Oncol 16(6):1553–1559PubMedCrossRefGoogle Scholar
  27. 27.
    Gruenberger B, Tamandl D, Schueller J et al (2008) Bevacizumab, capecitabine, and oxaliplatin as neoadjuvant therapy for patients with potentially curable metastatic colorectal cancer. J Clin Oncol 26(11):1830–1835PubMedCrossRefGoogle Scholar
  28. 28.
    Klinger M, Eipeldauer S, Hacker S et al (2009) Bevacizumab protects against sinusoidal obstruction syndrome and does not increase response rate in neoadjuvant XELOX/FOLFOX therapy of colorectal cancer liver metastases. Eur J Surg Oncol 35(5):515–520PubMedCrossRefGoogle Scholar
  29. 29.
    Kawano Y, Akimaru K, Takubo K et al (2006) Jejunectomy can reduce excessively elevated portal pressure after major hepatectomy in beagle dogs. J Surg Res 130(1):24–33PubMedCrossRefGoogle Scholar
  30. 30.
    van den Broek MA, Bloemen JG, Dello SA et al (2011) Randomized controlled trial analyzing the effect of 15 or 30 min intermittent Pringle maneuver on hepatocellular damage during liver surgery. J Hepatol 55(2):337–345PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Simon A.W.G. Dello
    • 1
  • Petra G. Serbanescu Kele
    • 2
  • Robert J. Porte
    • 3
  • Ronald M. van Dam
    • 1
  • Joost M. Klaase
    • 4
  • Cees Verhoef
    • 5
  • Thomas van Gulik
    • 6
  • Quintus Molenaar
    • 7
  • Koop Bosscha
    • 8
  • Eric J. van der Jagt
    • 2
  • Cornelis H.C. Dejong
    • 1
  • Marieke T. de Boer
    • 3
  1. 1.Department of Surgery, Maastricht University Medical Center & Nutrim School for Nutrition, Toxicology and MetabolismMaastricht UniversityMaastrichtThe Netherlands
  2. 2.Department of RadiologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
  3. 3.Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  4. 4.Department of SurgeryMedisch Spectrum TwenteEnschedeThe Netherlands
  5. 5.Department of Surgery, Erasmus Medical CentreErasmus UniversityRotterdamThe Netherlands
  6. 6.Department of Surgery, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  7. 7.Department of SurgeryUniversity Medical Centre Utrecht, University of UtrechtUtrechtThe Netherlands
  8. 8.Department of SurgeryJeroen Bosch HospitalHertogenboschThe Netherlands

Personalised recommendations