title: Chemotherapy-associated liver injury in patients with colorectal liver metastases: a systematic review and meta-analysis.
abstract: BACKGROUND
  Chemotherapy-associated liver injury is a major cause for concern when treating patients with colorectal liver metastases. The aim of this review was to determine the pathological effect of specific chemotherapy regimens on the hepatic parenchyma as well as on surgical morbidity, mortality and overall survival.
  
  
  METHODS
  A systematic review of the published literature and a meta-analysis were performed. For each of the variables under consideration, the effects of different chemotherapy regimens were determined by calculation of relative risks by a random-effects model.
  
  
  RESULTS
  Hepatic parenchymal injury is regimen specific, with oxaliplatin-based regimens being associated with grade 2 or greater sinusoidal injury (number needed to harm 8; 95 % confidence interval [CI] 6.4-13.6), whereas irinotecan-based regimens associated with steatohepatitis (number needed to harm 12; 95 % CI 7.8-26). The use of bevacizumab alongside FOLFOX reduces the risk of grade 2 or greater sinusoidal injury (relative risk 0.34; 95 % CI 0.15-0.75).
  
  
  CONCLUSIONS
  Chemotherapy before resection of colorectal liver metastases is associated with an increased risk of regimen-specific liver injury. This liver injury may have implications for the functional reserve of the liver for patients undergoing major hepatectomy for colorectal liver metastases.
authors: Department of HPB Surgery, Freeman Hospital, Newcastle upon Tyne, UK. s.m.robinson@ncl.ac.uk
authors: Stuart M
authors: SM
authors: Robinson
authors: Colin H
authors: CH
authors: Wilson
authors: Alastair D
authors: AD
authors: Burt
authors: Derek M
authors: DM
authors: Manas
authors: Steven A
authors: SA
authors: White
mesh_terms: D006801:Humans; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology; D005234:Fatty Liver / Q000139:chemically induced; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D011379:Prognosis