title: Hepatic steatosis, body mass index and long term outcome in patients undergoing hepatectomy for colorectal liver metastases.
abstract: BACKGROUND
  Hepatic steatosis (HS) is as an independent risk factor for morbidity and mortality post-hepatectomy. Recent studies report significant correlation between chemotherapy (now frequently employed pre-hepatectomy for colorectal liver metastases (CRLM)), HS and steatohepatitis. Furthermore, raised body mass index (BMI) predisposes to HS. However, no previous study has analysed the effect of HS on long-term survival.
  
  
  METHODS
  A retrospective analysis of a prospective consecutive cohort of 102 patients undergoing hepatectomy with 60 months follow-up data was performed. Resection specimens were examined histologically and the degree of steatosis graded accordingly. The data was compared to BMIs and other clinical characteristics. Statistical analyses included log-rank, contingency, logistic regression and Fisher's exact tests.
  
  
  RESULTS
  No detectable fatty change in 27 patients; 1 patient had cirrhosis; 57 had HS: 26 graded mild; 10 moderate, 21 severe and 17 not graded. 1 patient (BMI 29.5 kg/m(2)) had steatohepatitis but survived surgery. No significant difference in median survival between patients with and without HS (28.6 vs. 32.3 months, log-rank p>0.05). Results were similar between patients with BMI<25 and BMI>or=25 (32.3 vs. 36.8 months, log-rank p>0.05). Analyses of BMI against steatosis grade showed that patients with a higher BMI were at an increased risk of having a more severe HS (logistic regression, p<0.01; Fisher's exact, p<0.01). Contingency analyses on the influence of diabetes, chemotherapy and increasing number of risk factors on the likelihood of obtaining HS were insignificant (Fisher's exact, all p>0.05).
  
  
  CONCLUSIONS
  While patients with higher body mass index values are at increased risk of having more severe hepatic steatosis, neither BMI nor hepatic steatosis significantly influences long-term survival. We conclude therefore that neither obesity nor hepatic steatosis has significant prognostic relevance on long-term survival of CRLM patients undergoing hepatectomy.
authors.affiliation: Department of General Surgery, University Hospital Aintree, United Kingdom. samirpathak@doctors.net.uk
authors.forename: S
authors.initials: S
authors.lastname: Pathak
authors.forename: J M F
authors.initials: JM
authors.lastname: Tang
authors.forename: M
authors.initials: M
authors.lastname: Terlizzo
authors.forename: G J
authors.initials: GJ
authors.lastname: Poston
authors.forename: Hassan Z
authors.initials: HZ
authors.lastname: Malik
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015992:Body Mass Index; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D048909:Diabetes Complications; D005234:Fatty Liver / Q000209:etiology* / Q000473:pathology; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate