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Preoperative Chemotherapy for Colorectal Liver Metastases: Impact on Hepatic Histology and Postoperative Outcome

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Some investigators have suggested that preoperative chemotherapy for hepatic colorectal metastases may cause hepatic injury and increase perioperative morbidity and mortality. The objective of the current study was to examine whether treatment with preoperative chemotherapy was associated with hepatic injury of the nontumorous liver and whether such injury, if present, was associated with increased morbidity or mortality after hepatic resection. Two-hundred and twelve eligible patients who underwent hepatic resection for colorectal liver metastases between January 1999 and December 2005 were identified. Data on demographics, clinicopathologic characteristics, and preoperative chemotherapy details were collected and analyzed. The majority of patients received preoperative chemotherapy (n = 153; 72.2%). Chemotherapy consisted of fluoropyrimidine-based regimens: 5-FU monotherapy, 31.6%; irinotecan, 25.9%; and oxaliplatin, 14.6%. Among those patients who received chemotherapy, the type of chemotherapy regimen predicted distinct patterns of liver injury. Oxaliplatin was associated with increased likelihood of grade 3 sinusoidal dilatation (p = 0.017). Steatosis >30% was associated with irinotecan (27.3%) compared with no chemotherapy, 5-FU monotherapy, and oxaliplatin (all p < 0.05). Irinotecan also was associated with steatohepatitis, as two of the three patients with steatohepatitis had received irinotecan preoperatively. Overall, the perioperative complication rate was similar between the no-chemotherapy group (30.5%) and the chemotherapy group (35.3%) (p = 0.79). Preoperative chemotherapy was also not associated with 60-day mortality. In patients with hepatic colorectal metastases, preoperative chemotherapy is associated with hepatic injury in about 20 to 30% of patients. Furthermore, the type of hepatic injury after preoperative chemotherapy was regimen-specific.

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Acknowledgment

Ana L. Gleisner is supported by grants from Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior (CAPES) and an International Union Against Cancer (UICC) American Cancer Society Beginning Investigators Fellowship.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Halsted 614, Baltimore, MD, 22187-6681, USA

    Timothy M. Pawlik, Kelly Olino, Ana Luiza Gleisner, Richard Schulick & Michael A. Choti

  2. Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael Torbenson

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  1. Timothy M. Pawlik
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  2. Kelly Olino
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Correspondence to Michael A. Choti.

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Pawlik, T.M., Olino, K., Gleisner, A.L. et al. Preoperative Chemotherapy for Colorectal Liver Metastases: Impact on Hepatic Histology and Postoperative Outcome. J Gastrointest Surg 11, 860–868 (2007). https://doi.org/10.1007/s11605-007-0149-4

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  • DOI: https://doi.org/10.1007/s11605-007-0149-4

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