Systematic review of the influence of chemotherapy-associated liver injury on outcome after partial hepatectomy for colorectal liver metastases

J Zhao, K M C van Mierlo, J Gómez-Ramírez, H Kim, C H C Pilgrim, P Pessaux, S S Rensen, E P van der Stok, F G Schaap, O Soubrane, T Takamoto, L Viganò, B Winkens, C H C Dejong, S W M Olde Damink, Chemotherapy-Associated Liver Injury (CALI) consortium

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

BACKGROUND: The impact of chemotherapy-associated liver injury (CALI) on postoperative outcome in patients undergoing partial hepatectomy for colorectal liver metastases (CRLM) remains controversial. The objective of this study was to clarify the effect of CALI (sinusoidal dilatation (SD), steatosis and steatohepatitis) on postoperative morbidity and mortality by investigating a large data set from multiple international centres.

METHODS: PubMed and Embase were searched for studies published between 1 January 2004 and 31 December 2013 with keywords 'chemotherapy', 'liver resection', 'outcome' and 'colorectal metastases' to identify potential collaborating centres. Univariable and multivariable analyses were performed using binary logistic regression models, with results presented as odds ratios (ORs) with 95 per cent confidence intervals.

RESULTS: A consolidated database comprising 788 patients who underwent hepatectomy for CRLM in eight centres was obtained. In multivariable analyses, severe SD was associated with increased major morbidity (Dindo-Clavien grade III-V; OR 1·73, 95 per cent c.i. 1·02 to 2·95; P = 0·043). Severe steatosis was associated with decreased liver surgery-specific complications (OR 0·52, 95 per cent c.i. 0·27 to 1·00; P = 0·049), whereas steatohepatitis was linked to an increase in these complications (OR 2·08, 1·18 to 3·66; P = 0·012). Subgroup analysis showed that lobular inflammation was the sole component associated with increased overall morbidity (OR 2·22, 1·48 to 3·34; P = 0·001) and liver surgery-specific complications (OR 3·35, 2·11 to 5·32; P < 0·001). Finally, oxaliplatin treatment was linked to severe SD (OR 2·74, 1·67 to 4·49; P < 0·001).

CONCLUSION: An increase in postoperative major morbidity and liver surgery-specific complications was observed after partial hepatectomy in patients with severe SD and steatohepatitis. Postoperative liver failure occurred more often in patients with severe SD.

Original languageEnglish
Pages (from-to)990-1002
Number of pages13
JournalBritish Journal of Surgery
Volume104
Issue number8
DOIs
Publication statusPublished - Jul 2017

Keywords

  • Antineoplastic Combined Chemotherapy Protocols
  • Chemical and Drug Induced Liver Injury
  • Colorectal Neoplasms
  • Fatty Liver
  • Female
  • Hepatectomy
  • Humans
  • Length of Stay
  • Liver Failure, Acute
  • Liver Neoplasms
  • Male
  • Middle Aged
  • Postoperative Complications
  • Journal Article
  • Meta-Analysis
  • Review
  • INCREASES MORBIDITY
  • NONALCOHOLIC STEATOHEPATITIS
  • RAT MODEL
  • NODULAR REGENERATIVE HYPERPLASIA
  • PREOPERATIVE CHEMOTHERAPY
  • NEOADJUVANT CHEMOTHERAPY
  • OXALIPLATIN-BASED CHEMOTHERAPY
  • MAJOR HEPATECTOMY
  • INDUCED HEPATIC-INJURY
  • SINUSOIDAL OBSTRUCTION SYNDROME

Cite this

Zhao, J., van Mierlo, K. M. C., Gómez-Ramírez, J., Kim, H., Pilgrim, C. H. C., Pessaux, P., Rensen, S. S., van der Stok, E. P., Schaap, F. G., Soubrane, O., Takamoto, T., Viganò, L., Winkens, B., Dejong, C. H. C., Olde Damink, S. W. M., & Chemotherapy-Associated Liver Injury (CALI) consortium (2017). Systematic review of the influence of chemotherapy-associated liver injury on outcome after partial hepatectomy for colorectal liver metastases. British Journal of Surgery, 104(8), 990-1002. https://doi.org/10.1002/bjs.10572