Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Surg. Mar 27, 2013; 5(3): 30-36
Published online Mar 27, 2013. doi: 10.4240/wjgs.v5.i3.30
Hepatic histopathology and postoperative outcome after preoperative chemotherapy for Chinese patients with colorectal liver metastases
Qi-Ying Lu, Ai-Lian Zhao, Wei Deng, Zhong-Wu Li, Lin Shen
Qi-Ying Lu, Wei Deng, Lin Shen, Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing 100142, China
Ai-Lian Zhao, Zhong-Wu Li, Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing 100142, China
Author contributions: Both Lu QY and Zhao AL contributed equally to the study as the principal authors, participated in collecting raw data, reviewing the literature, writing the manuscript, as well as the pathology review and statistical analysis; Deng W and Li ZW provided the support to collect raw clinical data and approved the manuscript; Shen L designed the study, revised and approved the manuscript.
Supported by National Science and Technology Major Project Grant, No. 2011ZX09302-001-02
Correspondence to: Dr. Lin Shen, Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing 100142, China. lin100@medmail.com.cn
Telephone: +86-21-61590309 Fax: +86-21-61590703
Received: June 10, 2012
Revised: October 3, 2012
Accepted: December 20, 2012
Published online: March 27, 2013
Abstract

AIM: To assess the effects of preoperative treatment on the hepatic histology of non-tumoral liver and the postoperative outcome.

METHODS: One hundred and six patients underwent hepatic resection for colorectal metastases between 1999 and 2009. The surgical specimens were reviewed with established criteria for diagnosis and grading of pathological hepatic injury. The impact of preoperative therapy on liver injury and postoperative outcome was analyzed.

RESULTS: Fifty-three patients (50%) received surgery alone, whereas 42 patients (39.6%) received neoadjuvant chemotherapy and 11 (10.4%) patients received preoperative hepatic artery infusion (HAI). Chemotherapy included oxaliplatin-based regimens (31.1%) and irinotecan-based regimens (8.5%). On histopathological analysis, 16 patients (15.1%) had steatosis, 31 (29.2%) had sinusoidal dilation and 20 patients (18.9%) had steatohepatitis. Preoperative oxaliplatin was associated with sinusoidal dilation compared with surgery alone (42.4% vs 20.8%, P = 0.03); however, the perioperative complication rate was not significantly different between the oxaliplatin group and surgery group (27.3% vs 13.2%, P = 0.1). HAI was associated with more steatosis, sinusoidal dilation and steatohepatitis than the surgery group, with higher perioperative morbidity (36.4% vs 13.2%, P = 0.06) and mortality (9.1% vs 0% P = 0.02).

CONCLUSION: Preoperative oxaliplatin was associated with sinusoidal dilation compared with surgery alone. However, the preoperative oxaliplatin had no significant impact on perioperative outcomes. HAI can cause pathological changes and tends to increase perioperative morbidity and mortality.

Keywords: Drug liver injury; Preoperative chemotherapy; Hepatic artery infusion; Sinusoidal dilation