title: Neoadjuvant chemotherapy does not affect future liver remnant growth and outcomes of associating liver partition and portal vein ligation for staged hepatectomy.
abstract: The only potentially curative treatment for patients with colorectal liver metastases is hepatectomy. Associating liver partition and portal vein ligation for staged hepatectomy has emerged as a method of treatment for patients with inadequate future liver remnant. One concern about associating liver partition and portal vein ligation for staged hepatectomy is that preoperative chemotherapy may negatively affect the volume increase of the future liver remnant and outcomes.
  
  
  
  This study from the International Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Registry (NCT01924741) includes 442 patients with colorectal liver metastases registered from 2012-2016. Future liver remnant hypertrophy (absolute increase, percent increase, and kinetic growth rate) and clinical outcome were analyzed retrospectively in relation to type and amount of chemotherapy. The analyzed groups included patients with no chemotherapy, 1 regimen of chemotherapy, >1 regimen, and a group that received monoclonal antibodies in addition to chemotherapy.
  
  
  
  Ninety percent of the patients received neoadjuvant oncologic therapy including 42% with 1 regimen of chemotherapy, 44% with monoclonal antibodies, and 4% with >1 regimen. Future liver remnant increased between 74-92% with the largest increase in the group with 1 regimen of chemotherapy. The increase in milliliters was between 241 mL (>1 regimen) and 306 mL (1 regimen). Kinetic growth rate was between 14-18% per week and was greatest for the group with 1 regimen of chemotherapy. No statistical significance was found between the groups with any of the measurements of future liver remnant hypertrophy.
  
  
  
  Neoadjuvant chemotherapy, including monoclonal antibodies, does not negatively affect future liver remnant growth. Patients with colorectal liver metastases who might be potential candidates for associating liver partition and portal vein ligation for staged hepatectomy should be considered for neoadjuvant chemotherapy.
authors.affiliation: Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Hasselgren
authors.affiliation: Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, Division of Surgical and Interventional Sciences, University College London, Royal Free Hospital, London, United Kingdom.
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagò
authors.affiliation: Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, Division of Surgical and Interventional Sciences, University College London, Royal Free Hospital, London, United Kingdom.
authors.forename: Soumil
authors.initials: S
authors.lastname: Vyas
authors.affiliation: Department of General Surgery, Liver Transplant Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain.
authors.forename: Ricardo Robles
authors.initials: RR
authors.lastname: Campos
authors.affiliation: Department of General Surgery, Liver Transplant Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Brusadin
authors.affiliation: Department of Surgery and Transplantation, Swiss Hepatopancreaticobiliary and Transplant Center Zürich, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Linecker
authors.affiliation: Department of Surgery and Transplantation, Swiss Hepatopancreaticobiliary and Transplant Center Zürich, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Henrik
authors.initials: H
authors.lastname: Petrowsky
authors.affiliation: Department of Surgery and Transplantation, Swiss Hepatopancreaticobiliary and Transplant Center Zürich, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Pierre Alain
authors.initials: PA
authors.lastname: Clavien
authors.affiliation: Department of Surgery, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Marcel Autran
authors.initials: MA
authors.lastname: Machado
authors.affiliation: Division of Transplantation, Hepatobiliary Surgery, University of Rochester, Rochester, NY.
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernandez-Alejandro
authors.affiliation: Department of Surgery, Western University, London, Ontario, Canada.
authors.forename: Kerollos
authors.initials: K
authors.lastname: Wanis
authors.affiliation: Research and Development Unit in Local Healthcare, Linköping University, Linköping, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Valter
authors.affiliation: Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Sandström
authors.affiliation: Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Electronic address: bergthor.bjornsson@liu.se.
authors.forename: Bergthor
authors.initials: B
authors.lastname: Björnsson
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology / Q000628:therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008026:Ligation; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011169:Portal Vein / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents