Nodular regenerative hyperplasia: a deleterious consequence of chemotherapy for colorectal liver metastases?
OBJECTIVE
This report describes three patients suffering from nodular regenerative hyperplasia (NRH).


METHODS
These patients have received six, 16 and 20 cycles of neoadjuvant 5-fluorouracil and oxaliplatin-based chemotherapy before planned extended hepatectomy. Two patients underwent uneventful portal vein embolization to hypertrophy the future remnant liver.


RESULTS
At the end of chemotherapy, liver function tests deteriorated and portal hypertension appeared in two patients, including ascites, splenomegaly and oesophageal varices. Liver biopsy was performed through a percutaneous (two patients) or a transjugular approach (one patient) and allowed the diagnosis of NRH, which was considered to be a contraindication for major liver resection in all three patients, associated with extrahepatic disease progression in one patient. All patients died from neoplastic disease progression despite further chemotherapy at 6, 17 and 31 months following the diagnosis of NRH. One patient developed liver failure and ascites at the time of death.


CONCLUSIONS
Physicians should be aware of the potential occurrence and therapeutic impact of NRH in patients suffering from CRLM and treated by neoadjuvant 5FU-oxaliplatin-based chemotherapy before major liver surgery.
Hubert
Catherine
C
Department of Abdominal Surgery and Transplantation, Division of Hepato-Biliary and Pancreatic Surgery, Saint-Luc University Hospital, Université Catholique de Louvain (UCL), Brussels, Belgium.
Sempoux
Christine
C
Horsmans
Yves
Y
Rahier
Jacques
J
Humblet
Yves
Y
Machiels
Jean-Pascal
JP
Ceratti
Antonino
A
Canon
Jean-Luc
JL
Gigot
Jean-François
JF
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000075202:Contraindications; D018450:Disease Progression; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006498:Hepatectomy; D006801:Humans; D006965:Hyperplasia; D008099:Liver / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D008107:Liver Diseases / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008115:Liver Regeneration / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D013997:Time Factors; D016896:Treatment Outcome
D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D005472:Fluorouracil