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Sinusoidal Obstruction Syndrome Impairs Long-Term Outcome of Colorectal Liver Metastases Treated with Resection after Neoadjuvant Chemotherapy

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Chemotherapy-induced liver injury is a considerable problem in patients undergoing surgery for colorectal liver metastases, since an increase in postoperative morbidity and mortality has been observed. We investigated whether liver damage had further implications on long-term outcome in these patients.

Materials and Methods

Liver specimens from 196 patients resected for colorectal liver metastases were evaluated for chemotherapy-associated hepatic damage in the nontumorous liver. Injury patterns were correlated with recurrence free (RFS) and overall survival (OS). Factors leading to sinusoidal injury were identified.

Results

Patients who developed grade 2 or 3 sinusoidal dilatation had a significantly shorter RFS (hazard ratio [HR] 2.05; 95% confidence interval [95% CI] 1.23–3.39, P = .005) and OS (HR 2.90; 95% CI 1.61–6.19, P < .001), compared to patients without this alteration. Those patients also had significantly more intrahepatic recurrences (66.7% vs 30.5%, P = .003). Other patterns of chemotherapy-associated liver damage (nonalcoholic steatohepatitis, fibrosis) were not associated with impaired survival. Factors indicating sinusoidal injury were oxaliplatin-based chemotherapy, tumor size >5 cm, and elevated alkaline phosphatase or gamma glutamyltransferase.

Conclusions

Sinusoidal obstruction syndrome due to oxaliplatin-based chemotherapy may not only compromise perioperative outcome, but can lead to early recurrence and decreased survival in the long term. Strategies to prevent this condition are clearly needed.

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Authors and Affiliations

  1. Department of Surgery, Medical University of Vienna, Vienna, Austria

    Dietmar Tamandl MD, Markus Klinger MD, Beata Herberger BSc, Klaus Kaczirek MD & Thomas Gruenberger MD

  2. Department of Pathology, Medical University of Vienna, Vienna, Austria

    Sandra Eipeldauer MD

  3. Department of Internal Medicine, Division of Oncology, Krankenanstalt Barmherzige Brüder, Vienna, Austria

    Birgit Gruenberger MD

Authors
  1. Dietmar Tamandl MD
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  2. Markus Klinger MD
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  3. Sandra Eipeldauer MD
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  4. Beata Herberger BSc
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  5. Klaus Kaczirek MD
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  6. Birgit Gruenberger MD
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  7. Thomas Gruenberger MD
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Correspondence to Dietmar Tamandl MD.

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Tamandl, D., Klinger, M., Eipeldauer, S. et al. Sinusoidal Obstruction Syndrome Impairs Long-Term Outcome of Colorectal Liver Metastases Treated with Resection after Neoadjuvant Chemotherapy. Ann Surg Oncol 18, 421–430 (2011). https://doi.org/10.1245/s10434-010-1317-4

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  • DOI: https://doi.org/10.1245/s10434-010-1317-4

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