Sinusoidal Injury Increases Morbidity After Major... : Annals of Surgery (original) (raw)

Original Articles

Sinusoidal Injury Increases Morbidity After Major Hepatectomy in Patients With Colorectal Liver Metastases Receiving Preoperative Chemotherapy

Nakano, Hiroshi MD, PhD*; Oussoultzoglou, Elie MD*; Rosso, Edoardo MD*; Casnedi, Selenia MD†; Chenard-Neu, Marie-Pierre MD, PhD†; Dufour, Patrick MD‡; Bachellier, Philippe MD*; Jaeck, Daniel MD, PhD, FRCS*

From the *Centre de Chirurgie Viscérale et de Transplantation; †Service d'Anatomie Pathologique, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur, Avenue Molière; and ‡Centre Paul Strauss, Centre Régional de Lutte contre le Cancer de Strasbourg, 3 rue de la Porte de l'Hôpital, Strasbourg, France.

Reprints: Daniel Jaeck, MD, PhD, FRCS, Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur, Avenue Molière, 67200 Strasbourg, France. E-mail: [email protected].

Objective:

To investigate whether sinusoidal injury (SI) was associated with a worse outcome after hepatectomy in patients with colorectal liver metastases (CRLM).

Background:

Correlation between SI and oxaliplatin-based chemotherapy (OBC) was recently shown in patients with CRLM. However, it has yet to be fully clarified whether SI affects liver functional reserve and outcome after hepatectomy.

Patients and Methods:

Between 2003 and 2005, 90 patients with CRLM who underwent an elective hepatectomy after preoperative chemotherapies were included. Diagnosis of SI was established pathologically in the nontumoral liver parenchyma of the resected specimens, and perioperative data were assessed in these patients.

Results:

OBC was significantly associated with a higher incidence of SI. Preoperative indocyanine green retention rate at 15 minutes (ICG-R15) and postoperative value of total-bilirubin were significantly higher, and hospital stay was significantly longer in patients presenting with SI. Multivariate analysis showed that female gender, administration of 6 cycles or more of OBC, abnormal value of preoperative aspartate aminotransferase >36 IU/L, or abnormal value of preoperative ICG-R15 (>10%) were preoperative factors significantly associated with SI. Among patients undergoing a major hepatectomy, SI was significantly associated with higher morbidity and longer hospital stay.

Conclusion:

The present study suggests that SI resulted in a poorer liver functional reserve and in a higher complication rate after major hepatectomy. Therefore, female patients who received 6 cycles or more of OBC, or presenting with abnormal preoperative aspartate aminotransferase and ICG-R15 values should be carefully selected before deciding to undertake a major hepatectomy.