Christoph Reissfelder1, Karsten Brand2, Julia Sobiegalla3, Nuh N Rahbari3, Ulrich Bork4, Peter Schirmacher2, Markus W Büchler3, Jürgen Weitz4, Moritz Koch4. 1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; Department of Visceral, Thoracic and Vascular Surgery, University of Dresden, Dresden, Germany. Electronic address: christoph.reissfelder@med.uni-heidelberg.de. 2. Department of Pathology, University of Heidelberg, Heidelberg, Germany. 3. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. 4. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; Department of Visceral, Thoracic and Vascular Surgery, University of Dresden, Dresden, Germany.
Abstract
BACKGROUND: Advances in neoadjuvant therapy enabled novel strategies for treating resectable and initially unresectable colorectal cancer liver metastases. Although it is well known that chemotherapeutic agents cause certain types of liver parenchymal injury, the actual contribution of chemotherapy-associated hepatotoxicity to postoperative morbidity remains poorly defined. The aim of this study was to define all kinds of chemotherapy-associated liver injury and to examine its impact on postoperative morbidity. PATIENTS AND METHODS: We included 119 patients who were treated between 2002 and 2010. Chemotherapy-associated changes of the liver were subclassified in 11 different categories and correlated with postoperative morbidity with the ultimate aim of generating a liver injury risk score. RESULTS: On univariate analysis severity (P = .004) and localization of parenchymal inflammation (P = .04) were associated with morbidity. Steatosis did not correlate with postoperative outcome (P = .69), whereas steatohepatitis (as assessed by the nonalcoholic fatty liver disease activity score score) was related with morbidity (P = .03). On multivariate analysis, the severity of inflammation (95% confidence interval, 1.008-6.526; odds ratio, 2.56; P = .04) was significantly correlated with postoperative morbidity. The newly developed liver injury risk score was highly associated with postoperative complications (P = .006). CONCLUSION: In this study, the induction of inflammation by conventional chemotherapy and its relevance for the development of clinical complications could be demonstrated. The proposed risk score for liver injury-related morbidity might help to better select patients eligible for an operation.
BACKGROUND: Advances in neoadjuvant therapy enabled novel strategies for treating resectable and initially unresectable colorectal cancer liver metastases. Although it is well known that chemotherapeutic agents cause certain types of liver parenchymal injury, the actual contribution of chemotherapy-associated hepatotoxicity to postoperative morbidity remains poorly defined. The aim of this study was to define all kinds of chemotherapy-associated liver injury and to examine its impact on postoperative morbidity. PATIENTS AND METHODS: We included 119 patients who were treated between 2002 and 2010. Chemotherapy-associated changes of the liver were subclassified in 11 different categories and correlated with postoperative morbidity with the ultimate aim of generating a liver injury risk score. RESULTS: On univariate analysis severity (P = .004) and localization of parenchymal inflammation (P = .04) were associated with morbidity. Steatosis did not correlate with postoperative outcome (P = .69), whereas steatohepatitis (as assessed by the nonalcoholic fatty liver disease activity score score) was related with morbidity (P = .03). On multivariate analysis, the severity of inflammation (95% confidence interval, 1.008-6.526; odds ratio, 2.56; P = .04) was significantly correlated with postoperative morbidity. The newly developed liver injury risk score was highly associated with postoperative complications (P = .006). CONCLUSION: In this study, the induction of inflammation by conventional chemotherapy and its relevance for the development of clinical complications could be demonstrated. The proposed risk score for liver injury-related morbidity might help to better select patients eligible for an operation.
Authors: Cui Yang; Nuh N Rahbari; Sören Torge Mees; Felix Schaab; Moritz Koch; Jürgen Weitz; Christoph Reissfelder Journal: Langenbecks Arch Surg Date: 2015-06-08 Impact factor: 3.445
Authors: Eun L Langman; Paul V Suhocki; Herbert I Hurwitz; Michael A Morse; Rebecca A Burbridge; Tony P Smith; Charles Y Kim Journal: J Gastrointest Oncol Date: 2016-12
Authors: Maximilian Jara; Jan Bednarsch; Maciej Malinowski; Johann Pratschke; Martin Stockmann Journal: Langenbecks Arch Surg Date: 2015-10-27 Impact factor: 3.445
Authors: Marco Massani; Giovanni Capovilla; Cesare Ruffolo; Roberta Bonariol; Paola Maccatrozzo; Francesco Tuci; Giuseppe Battistella; Gian Luca Grazi; Nicolò Bassi Journal: Mol Clin Oncol Date: 2017-08-01