J Zhao1, K M C van Mierlo1, J Gómez-Ramírez2, H Kim3, C H C Pilgrim4, P Pessaux5, S S Rensen1, E P van der Stok6, F G Schaap1, O Soubrane7, T Takamoto8, L Viganò9, B Winkens10, C H C Dejong1,11, S W M Olde Damink1,12. 1. Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands. 2. Hepatopancreaticobiliary Surgery Unit, Department of Surgery, Hospital Universitario de la Princesa, Madrid, Spain. 3. Department of Pathology, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seongnam, Korea. 4. Hepatopancreaticobiliary Service, Upper Gastrointestinal Surgery, The Alfred Hospital, and Division of Cancer Surgery, Peter MacCallum Cancer Centre, Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia. 5. Digestive Surgery and Transplantation, Hôpital de Hautepierre, University Hospital of Strasbourg, Strasbourg, France. 6. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. 7. Department of Hepatobiliary Surgery and Liver Transplant, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris, Université Denis Diderot, Paris, France. 8. Department of Hepatopancreaticobiliary Surgery, Japanese Red Cross Medical Centre, Tokyo, Japan. 9. Division of Hepatobiliary and General Surgery, Humanitas Clinical and Research Centre, Humanitas University, Rozzano, Italy. 10. Department of Methodology and Statistics, Maastricht University Medical Centre, and CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands. 11. GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands. 12. Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, UK.
Abstract
BACKGROUND: The impact of chemotherapy-associated liver injury (CALI) on postoperative outcome in patients undergoing partial hepatectomy for colorectal liver metastases (CRLM) remains controversial. The objective of this study was to clarify the effect of CALI (sinusoidal dilatation (SD), steatosis and steatohepatitis) on postoperative morbidity and mortality by investigating a large data set from multiple international centres. METHODS: PubMed and Embase were searched for studies published between 1 January 2004 and 31 December 2013 with keywords 'chemotherapy', 'liver resection', 'outcome' and 'colorectal metastases' to identify potential collaborating centres. Univariable and multivariable analyses were performed using binary logistic regression models, with results presented as odds ratios (ORs) with 95 per cent confidence intervals. RESULTS: A consolidated database comprising 788 patients who underwent hepatectomy for CRLM in eight centres was obtained. In multivariable analyses, severe SD was associated with increased major morbidity (Dindo-Clavien grade III-V; OR 1·73, 95 per cent c.i. 1·02 to 2·95; P = 0·043). Severe steatosis was associated with decreased liver surgery-specific complications (OR 0·52, 95 per cent c.i. 0·27 to 1·00; P = 0·049), whereas steatohepatitis was linked to an increase in these complications (OR 2·08, 1·18 to 3·66; P = 0·012). Subgroup analysis showed that lobular inflammation was the sole component associated with increased overall morbidity (OR 2·22, 1·48 to 3·34; P = 0·001) and liver surgery-specific complications (OR 3·35, 2·11 to 5·32; P < 0·001). Finally, oxaliplatin treatment was linked to severe SD (OR 2·74, 1·67 to 4·49; P < 0·001). CONCLUSION: An increase in postoperative major morbidity and liver surgery-specific complications was observed after partial hepatectomy in patients with severe SD and steatohepatitis. Postoperative liver failure occurred more often in patients with severe SD.
BACKGROUND: The impact of chemotherapy-associated liver injury (CALI) on postoperative outcome in patients undergoing partial hepatectomy for colorectal liver metastases (CRLM) remains controversial. The objective of this study was to clarify the effect of CALI (sinusoidal dilatation (SD), steatosis and steatohepatitis) on postoperative morbidity and mortality by investigating a large data set from multiple international centres. METHODS: PubMed and Embase were searched for studies published between 1 January 2004 and 31 December 2013 with keywords 'chemotherapy', 'liver resection', 'outcome' and 'colorectal metastases' to identify potential collaborating centres. Univariable and multivariable analyses were performed using binary logistic regression models, with results presented as odds ratios (ORs) with 95 per cent confidence intervals. RESULTS: A consolidated database comprising 788 patients who underwent hepatectomy for CRLM in eight centres was obtained. In multivariable analyses, severe SD was associated with increased major morbidity (Dindo-Clavien grade III-V; OR 1·73, 95 per cent c.i. 1·02 to 2·95; P = 0·043). Severe steatosis was associated with decreased liver surgery-specific complications (OR 0·52, 95 per cent c.i. 0·27 to 1·00; P = 0·049), whereas steatohepatitis was linked to an increase in these complications (OR 2·08, 1·18 to 3·66; P = 0·012). Subgroup analysis showed that lobular inflammation was the sole component associated with increased overall morbidity (OR 2·22, 1·48 to 3·34; P = 0·001) and liver surgery-specific complications (OR 3·35, 2·11 to 5·32; P < 0·001). Finally, oxaliplatin treatment was linked to severe SD (OR 2·74, 1·67 to 4·49; P < 0·001). CONCLUSION: An increase in postoperative major morbidity and liver surgery-specific complications was observed after partial hepatectomy in patients with severe SD and steatohepatitis. Postoperative liver failure occurred more often in patients with severe SD.
Authors: Daniel Brown; Henry Krebs; Jayson Brower; Ryan O'Hara; Eric Wang; Kirubahara Vaheesan; Liping Du; Lea Matsuoka; Donna D'Souza; Daniel Y Sze; Jafar Golzarian; Ripal Gandhi; Andrew Kennedy Journal: J Gastrointest Oncol Date: 2021-04