Journal List > J Korean Surg Soc > v.80(1) > 1011262

Park, Kim, Kim, Paek, Oh, and Suh: Is Preoperative Chemotherapy Safe for Patients with Colorectal Liver Metastases Undergoing Metastasectomy?

Abstract

Purpose

Controversies regarding preoperative versus postoperative chemotherapy for patients having hepatic metastases of colorectal primary made us elucidate the safety of chemotherapy. By examining the histopathologic changes in the liver following preoperative chemotherapy and analyzing the relation between surgical outcomes and preoperative chemotherapy, we were able to answer whether preoperative chemotherapy is safe.

Methods

We analyzed 38 patients who underwent chemotherapy before resection of hepatic metastasis from colorectal primary, retrospectively. Types of chemotherapy regimen were FL (5-FU+ leucovorin), FOLFOX4 (oxaliplatin+5-FU+ leucovorin), and FOLFIRI (irinotecan+5-FU+ leucovorin). Results of liver function tests were compared before and after preoperative chemotherapy. One pathologist reviewed the degree of hepatic injury from resected specimens. Associations between the histological findings of hepatic injury and surgical outcomes and chemotherapeutic agents were examined.

Results

Histopathologic analysis revealed severe liver injury was present in 12 patients (31.6%). In further detail, moderate to severe sinusoidal dilatation was found in 3 patients (25%), steatosis of more than 30% was identified in 9 patients (75%), and steatohepatitis Kleiner score of ≥4 in 5 patients (41.7%). Preoperative chemotherapy did not affect the biochemical profiles of liver function. The overall perioperative complication rate was 5.3% (n=2). There was no difference in postoperative morbidity or mortality from reported results following hepatectomy.

Conclusion

We found preoperative chemotherapy definitely induced histopathologic changes of hepatotoxicities. Even so, preoperative chemotherapy did not increase morbidity or mortality after hepatic metastasectomy. Preoperative chemotherapy seems to be safe in performing curative hepatic resection for the metastases.

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Fig. 1.
Examples of the liver injury. (A) Sinusoidal dilatation. Moderate centrilobular sinusoidal distention is observed in a patient who received oxaliplatin, and the hepatic cords are atrophic due to the dilated sinusoids (H&E stain, ×400). (B) Moderate steatosis. Macrovesicular and microvesicular steatosis is observed in the hepatic lobule over a half of the area (H&E stain, ×400). (C) Steatohepatitis. The hepatocytes show ballooning degeneration, lobular inflammation, macrovesicular and microvesicular steatosis (Kleiner score 5) (H&E stain, ×400).
jkss-80-36f1.tif
Table 1.
Relationship between chemotherapy regimen and severe liver injury
Chemotherapy regimen Sinusoidal dilatation* (n=3) Steatosis >30% (n=9) Steatohepatitis(n=5) Incidence (%) P-value
5-FU alone (n=7) 0 1 1 28.6 0.395
Oxaliplatin+5-FU (n=20) 3 5 2 50.0  
Irinotecan+5-FU (n=11) 0 3 2 45.5  

* Rubbia-Brandt grade 2 or 3;

Kleiner score ≥4;

FU = fluorouracil.

Table 2.
Types of postoperative complication
Complication Number of patient (%)
Overall 2 (5.3)
Non-hepatic complications 0
Cardiovascular 0
Pulmonary 2
Acute renal failure 0
Ileus 0
Hemorrhage 0
Infection 0
Hepatic complications 0
Liver failure 0
Bile leak/biloma 0
Biliary stricture 0
Portal vein thrombosis 0
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