Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases.
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.
Vauthey
Jean-Nicolas
JN
Department of Surgical Oncology, Unit 444, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA. jvauthey@mdanderson.org
Pawlik
Timothy M
TM
Ribero
Dario
D
Wu
Tsung-Teh
TT
Zorzi
Daria
D
Hoff
Paulo M
PM
Xiong
Henry Q
HQ
Eng
Cathy
C
Lauwers
Gregory Y
GY
Mino-Kenudson
Mari
M
Risio
Mauro
M
Muratore
Andrea
A
Capussotti
Lorenzo
L
Curley
Steven A
SA
Abdalla
Eddie K
EK
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
D000970:Antineoplastic Agents