title: Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases.
abstract: OBJECTIVE
  Chemotherapy before resection of hepatic colorectal metastases (CRM) may cause hepatic injury and affect postoperative outcome.
  
  
  METHODS
  Four hundred six patients underwent hepatic resection of CRM between 1992 and 2005. Pathologic review of the nontumorous liver was performed using established criteria for steatosis, steatohepatitis, and sinusoidal injury. The effect of chemotherapy and liver injury on perioperative outcome was analyzed.
  
  
  RESULTS
  One hundred fifty-eight patients (38.9%) received no preoperative chemotherapy, whereas 248 patients (61.1%) did. The median duration of chemotherapy was 16 weeks (range, 2 to 70 weeks). Chemotherapy consisted of fluoropyrimidine-based regimens (fluorouracil [FU] alone, 15.5%; irinotecan plus FU, 23.1%; and oxaliplatin plus FU, 19.5%) and other therapy (3.0%). On pathologic analysis, 36 patients (8.9%) had steatosis, 34 (8.4%) had steatohepatitis, and 22 (5.4%) had sinusoidal dilation. Oxaliplatin was associated with sinusoidal dilation compared with no chemotherapy (18.9% v 1.9%, respectively; P < .001; odds ratio [OR] = 8.3; 95% CI, 2.9 to 23.6). In contrast, irinotecan was associated with steatohepatitis compared with no chemotherapy (20.2% v 4.4%, respectively; P < .001; OR = 5.4; 95% CI, 2.2 to 13.5). Patients with steatohepatitis had an increased 90-day mortality compared with patients who did not have steatohepatitis (14.7% v 1.6%, respectively; P = .001; OR = 10.5; 95% CI, 2.0 to 36.4).
  
  
  CONCLUSIONS
  Steatohepatitis is associated with an increased 90-day mortality after hepatic surgery. In patients with hepatic CRM, the chemotherapy regimen should be carefully considered because the risk of hepatotoxicity is significant.
authors.affiliation: Department of Surgical Oncology, Unit 444, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA. jvauthey@mdanderson.org
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Dario
authors.initials: D
authors.lastname: Ribero
authors.forename: Tsung-Teh
authors.initials: TT
authors.lastname: Wu
authors.forename: Daria
authors.initials: D
authors.lastname: Zorzi
authors.forename: Paulo M
authors.initials: PM
authors.lastname: Hoff
authors.forename: Henry Q
authors.initials: HQ
authors.lastname: Xiong
authors.forename: Cathy
authors.initials: C
authors.lastname: Eng
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: Mari
authors.initials: M
authors.lastname: Mino-Kenudson
authors.forename: Mauro
authors.initials: M
authors.lastname: Risio
authors.forename: Andrea
authors.initials: A
authors.lastname: Muratore
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
authors.forename: Eddie K
authors.initials: EK
authors.lastname: Abdalla
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015992:Body Mass Index; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D005234:Fatty Liver / Q000209:etiology* / Q000401:mortality; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged
chemical_list: D000970:Antineoplastic Agents