Jan C Mahlmann1, Thomas C Wirth2, Björn Hartleben3, Harald Schrem4, Jens F Mahlmann5, Alexander Kaltenborn1, Jürgen Klempnauer1, Ulf Kulik1. 1. General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany. 2. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. 3. Pathology, Hannover Medical School, Hannover, Germany. 4. Division of Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria. 5. Departament d'Astronomia i Astrofísica, Universitat de València, Valencia, Spain.
Abstract
BACKGROUND: Hepatic steatosis and chemotherapy in the treatment of colorectal liver metastases (CLM) are often linked to increased mortality and morbidity after liver resection. This study evaluates the influence of macrovesicular hepatic steatosis and chemotherapeutic regimes on graded morbidity and mortality after liver resection for CLM. METHODS: A total of 323 cases of liver resection for CLM were retrospectively analysed using univariable and multivariable linear, ordinal and Cox regression analyses. The resected liver tissue was re-evaluated by a single observer to determine the grade and type of hepatic steatosis. RESULTS: Macrovesicular steatosis did not influence postoperative morbidity and survival, as evidenced by risk-adjusted multivariable Cox regression analysis (p = 0.521). Conversion chemotherapy containing oxaliplatin was an independent and significant risk factor for mortality in risk-adjusted multivariable Cox regression analysis (p = 0.005). Identified independently, significant risk factors for postoperative morbidity were neoadjuvant treatment of metastases of the primary tumour with irinotecan (p = 0.003), the duration of surgery in minutes (p = 0.001) and the number of intraoperatively transfused packed red blood cells (p ≤ 0.001). Surprisingly, macrovesicular hepatic steatosis was not a risk factor for postoperative morbidity and was even associated with lower rates of complications (p = 0.006). CONCLUSION: The results emphasize the multifactorial influence of preoperative liver damage and chemotherapy on the severity of postoperative morbidity, as well as the significant impact of conversion chemotherapy containing oxaliplatin on survival.
BACKGROUND: Hepatic steatosis and chemotherapy in the treatment of colorectal liver metastases (CLM) are often linked to increased mortality and morbidity after liver resection. This study evaluates the influence of macrovesicular hepatic steatosis and chemotherapeutic regimes on graded morbidity and mortality after liver resection for CLM. METHODS: A total of 323 cases of liver resection for CLM were retrospectively analysed using univariable and multivariable linear, ordinal and Cox regression analyses. The resected liver tissue was re-evaluated by a single observer to determine the grade and type of hepatic steatosis. RESULTS: Macrovesicular steatosis did not influence postoperative morbidity and survival, as evidenced by risk-adjusted multivariable Cox regression analysis (p = 0.521). Conversion chemotherapy containing oxaliplatin was an independent and significant risk factor for mortality in risk-adjusted multivariable Cox regression analysis (p = 0.005). Identified independently, significant risk factors for postoperative morbidity were neoadjuvant treatment of metastases of the primary tumour with irinotecan (p = 0.003), the duration of surgery in minutes (p = 0.001) and the number of intraoperatively transfused packed red blood cells (p ≤ 0.001). Surprisingly, macrovesicular hepatic steatosis was not a risk factor for postoperative morbidity and was even associated with lower rates of complications (p = 0.006). CONCLUSION: The results emphasize the multifactorial influence of preoperative liver damage and chemotherapy on the severity of postoperative morbidity, as well as the significant impact of conversion chemotherapy containing oxaliplatin on survival.
Authors: Harald Schrem; Moritz Focken; Bridget Gunson; Benedikt Reichert; Darius Mirza; Hans-Heinrich Kreipe; Desley Neil; Alexander Kaltenborn; Alon Goldis; Christian Krauth; Keith Roberts; Thomas Becker; Jürgen Klempnauer; James Neuberger Journal: Liver Transpl Date: 2016-06 Impact factor: 5.799
Authors: Jeffrey Chakedis; Malcolm H Squires; Eliza W Beal; Tasha Hughes; Heather Lewis; Anghela Paredes; Mazen Al-Mansour; Steven Sun; Jordan M Cloyd; Timothy M Pawlik Journal: Curr Probl Surg Date: 2017-10-27 Impact factor: 1.909
Authors: Johan F Lock; Tilman Westphal; Tom Rubin; Maciej Malinowski; Antje Schulz; Maximilian Jara; Jan Bednarsch; Martin Stockmann Journal: Ann Surg Oncol Date: 2017-05-17 Impact factor: 5.344