Limiting factors for liver regeneration after a major hepatic resection for colorectal cancer metastases

Abstract

Background: Chemotherapy before resection of colorectal metastases in the liver is extensively used and has been shown to induce histopathological changes in the liver parenchyma, although little is known about the effect of chemotherapy on liver regeneration. The aim of this study was to determine if pre-operative chemotherapy influences the regenerated liver volume after a major liver resection.

Patients and methods: This retrospective cohort study included 74 patients subjected to a major liver resection for colorectal metastases. Patients were divided into two groups depending on whether they had been treated with chemotherapy less than 3 months before surgery or not. Liver volumes were measured before and 1 year after resection.

Results: Pre-operative chemotherapy reduced volumetric liver regeneration (83 ± 2% versus 91 ± 2%; P = 0.007) as compared with patients without chemotherapy. There was a linear correlation between regenerated volume and time interval between the end of chemotherapy to resection (P = 0.031).

Conclusions: Pre-operative chemotherapy in patients with colorectal liver metastases negatively affects volume regeneration after a partial hepatectomy. The time interval between chemotherapy and surgery determines the impact of these affects.

Figure 1

Correlation between regenerated volume and the time interval between cessation of chemotherapy and the operation. A linear correlation was found (r = 0.37, P = 0.031)

Figure 2

Regenerated volume as a function of the patient's age for groups without chemotherapy (a) and with chemotherapy (b). There was a negative linear correlation between parameters in groups (r = −0.36, P = 0.023 and r = −0.558, P = 0.0001, respectively)