title: Preoperative chemotherapy and the risk of hepatotoxicity and morbidity after liver resection for metastatic colorectal cancer: a single institution experience.
abstract: BACKGROUND
  Patients undergoing liver resection for colorectal cancer liver metastasis (CRCLM) are often treated with chemotherapy before surgery. However, the associations between chemotherapy, liver injury, perioperative outcomes, and other confounding factors remain unclear. This study investigates the effect of preoperative chemotherapy for CRCLM on nontumoral liver histology and perioperative outcomes in a contemporary cohort.
  
  
  METHODS
  Five hundred six patients underwent hepatic resection for CRCLM between April 2003 and March 2007. Histologic evaluation of nontumoral liver parenchyma for sinusoidal dilatation, steatosis, and steatohepatitis was performed in 384 cases for which tissue was available. Patient factors, tumor characteristics, chemotherapy regimens, histology of nontumoral liver, and perioperative morbidity were analyzed.
  
  
  RESULTS
  Two hundred fifty patients (65%) received preoperative chemotherapy for a median duration of 24 weeks. Irinotecan, increased body mass index (BMI), and diabetes mellitus (DM) were associated with hepatic steatosis and steatohepatitis. Sinusoidal dilatation was not associated with chemotherapy or any clinicopathologic factors. Perioperative blood transfusion was independently associated with an increased risk of any complication. Major postoperative complications were independently associated with major (≥ 3 segments) resections (57%) and perioperative blood transfusion. The use of any preoperative chemotherapy decreased the odds of major complications. Liver-related complications were independently associated with major resection and blood transfusion, but not with chemotherapy. Three postoperative deaths (0.8%) occurred, all in patients who were not treated with chemotherapy and had no evidence of liver injury.
  
  
  CONCLUSIONS
  With appropriate patient selection, liver resection for CRCLM can be safely performed in patients treated with preoperative chemotherapy.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Wolf
authors.forename: James O
authors.initials: JO
authors.lastname: Park
authors.forename: Fei
authors.initials: F
authors.lastname: Bao
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: Ronald P
authors.initials: RP
authors.lastname: DeMatteo
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
authors.forename: Mithat
authors.initials: M
authors.lastname: Gönen
authors.forename: Nancy
authors.initials: N
authors.lastname: Kemeny
authors.forename: Jinru
authors.initials: J
authors.lastname: Shia
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D000068258:Bevacizumab; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology*; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006498:Hepatectomy; D006801:Humans; D000077146:Irinotecan; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000068258:Bevacizumab; D000077146:Irinotecan; D005472:Fluorouracil; D002166:Camptothecin