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. 2013 Aug;20(8):2493-500.
doi: 10.1245/s10434-012-2864-7. Epub 2013 Feb 3.

Optimal future liver remnant in patients treated with extensive preoperative chemotherapy for colorectal liver metastases

Junichi Shindoh  1 , Ching-Wei D Tzeng, Thomas A Aloia, Steven A Curley, Giuseppe Zimmitti, Steven H Wei, Steven Y Huang, Armeen Mahvash, Sanjay Gupta, Michael J Wallace, Jean-Nicolas Vauthey
Affiliations

Optimal future liver remnant in patients treated with extensive preoperative chemotherapy for colorectal liver metastases

Junichi Shindoh et al. Ann Surg Oncol. 2013 Aug.

Abstract

Background: Patients with colorectal liver metastases (CLM) are increasingly treated with preoperative chemotherapy. Chemotherapy associated liver injury is associated with postoperative hepatic insufficiency (PHI) and mortality. The adequate minimum future liver remnant (FLR) volume in patients treated with extensive chemotherapy remains unknown.

Methods: All patients with standardized FLR > 20 %, who underwent extended right hepatectomy for CLM from 1993-2011, were divided into three cohorts by chemotherapy duration: no chemotherapy (NC, n = 30), short duration (SD, ≤12 weeks, n = 78), long duration (LD, >12 weeks, n = 86). PHI and mortality were compared by using uni-/multivariate analyses. Optimal FLR for LD chemotherapy was determined using a minimum p-value approach.

Results: A total of 194 patients met inclusion criteria. LD chemotherapy was significantly associated with PHI (NC + SD 3.7 vs. LD 16.3%, p = 0.006). Ninety-day mortality rates were 0 % in NC, 1.3 % in SD, and 2.3% in LD patients, respectively (p = 0.95). In patients with FLR > 30 %, PHI occurred in only two patients (both LD, 2/20, 10 %), but all patients with FLR > 30 % survived. The best cutoff of FLR for preventing PHI after chemotherapy >12 weeks was estimated as >30 %. Both LD chemotherapy (odds ratio [OR] 5.4, p = 0.004) and FLR ≤ 30 % (OR 6.3, p = 0.019) were independent predictors of PHI.

Conclusions: Preoperative chemotherapy >12 weeks increases the risk of PHI after extended right hepatectomy. In patients treated with long-duration chemotherapy, FLR > 30 % reduces the rate of PHI and may provide enough functional reserve for clinical rescue if PHI develops.

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Conflict of interest statement

CONFLICTS OF INTEREST Authors have no conflict of interest to disclose.

Figures

FIG. 1
FIG. 1
Study population
FIG. 2
FIG. 2
Postoperative liver insufficiency and mortality from liver failure. a FLR >20 %, b FLR >30 %. PHI postoperative hepatectomy insufficiency
FIG. 3
FIG. 3
Changes in odds ratio (a) and p-value in likelihood test (b) while adjusting cutoff value of FLR for prediction of postoperative hepatic insufficiency in patients treated with chemotherapy (>12 weeks). Cutoff value of FLR 29 % was associated with highest odds ratio and lowest p value in prediction of postoperative hepatic insufficiency
See this image and copyright information in PMC

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