Preoperative chemotherapy for colorectal liver metastases: Impact on hepatic histology and postoperative outcome

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

Research output: Contribution to journalArticle

185 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)860-868
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume11
Issue number7
DOIs
StatePublished - Jul 2007

Fingerprint

Histology
irinotecan
Neoplasm Metastasis
Drug Therapy
Liver
oxaliplatin
Wounds and Injuries
Fatty Liver
Fluorouracil
Mortality
Morbidity
Dilatation
Research Personnel
Demography

Keywords

  • Colorectal metastasis
  • Hepatic injury
  • Preoperative chemotherapy
  • Steatosis

ASJC Scopus subject areas

  • Surgery

Cite this

Preoperative chemotherapy for colorectal liver metastases : Impact on hepatic histology and postoperative outcome. / Pawlik, Timothy M.; Olino, Kelly; Gleisner, Ana Luiza; Torbenson, Michael; Schulick, Richard; Choti, Michael A.

In: Journal of Gastrointestinal Surgery, Vol. 11, No. 7, 07.2007, p. 860-868.

Research output: Contribution to journalArticle

Pawlik, Timothy M. ; Olino, Kelly ; Gleisner, Ana Luiza ; Torbenson, Michael ; Schulick, Richard ; Choti, Michael A. / Preoperative chemotherapy for colorectal liver metastases : Impact on hepatic histology and postoperative outcome. In: Journal of Gastrointestinal Surgery. 2007 ; Vol. 11, No. 7. pp. 860-868.
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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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