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Preoperative chemotherapy and the risk of hepatotoxicity and morbidity after liver resection for metastatic colorectal cancer: a single institution experience.

Publication ,  Journal Article
Wolf, PS; Park, JO; Bao, F; Allen, PJ; DeMatteo, RP; Fong, Y; Jarnagin, WR; Kingham, TP; Gönen, M; Kemeny, N; Shia, J; D'Angelica, MI
Published in: J Am Coll Surg
January 2013

BACKGROUND: Patients undergoing liver resection for colorectal cancer liver metastasis (CRCLM) are often treated with chemotherapy before surgery. However, the associations between chemotherapy, liver injury, perioperative outcomes, and other confounding factors remain unclear. This study investigates the effect of preoperative chemotherapy for CRCLM on nontumoral liver histology and perioperative outcomes in a contemporary cohort. STUDY DESIGN: Five hundred six patients underwent hepatic resection for CRCLM between April 2003 and March 2007. Histologic evaluation of nontumoral liver parenchyma for sinusoidal dilatation, steatosis, and steatohepatitis was performed in 384 cases for which tissue was available. Patient factors, tumor characteristics, chemotherapy regimens, histology of nontumoral liver, and perioperative morbidity were analyzed. RESULTS: Two hundred fifty patients (65%) received preoperative chemotherapy for a median duration of 24 weeks. Irinotecan, increased body mass index (BMI), and diabetes mellitus (DM) were associated with hepatic steatosis and steatohepatitis. Sinusoidal dilatation was not associated with chemotherapy or any clinicopathologic factors. Perioperative blood transfusion was independently associated with an increased risk of any complication. Major postoperative complications were independently associated with major (≥ 3 segments) resections (57%) and perioperative blood transfusion. The use of any preoperative chemotherapy decreased the odds of major complications. Liver-related complications were independently associated with major resection and blood transfusion, but not with chemotherapy. Three postoperative deaths (0.8%) occurred, all in patients who were not treated with chemotherapy and had no evidence of liver injury. CONCLUSIONS: With appropriate patient selection, liver resection for CRCLM can be safely performed in patients treated with preoperative chemotherapy.

Duke Scholars

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Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

January 2013

Volume

216

Issue

1

Start / End Page

41 / 49

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Oxaliplatin
  • Organoplatinum Compounds
  • Neoadjuvant Therapy
  • Multivariate Analysis
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
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Wolf, P. S., Park, J. O., Bao, F., Allen, P. J., DeMatteo, R. P., Fong, Y., … D’Angelica, M. I. (2013). Preoperative chemotherapy and the risk of hepatotoxicity and morbidity after liver resection for metastatic colorectal cancer: a single institution experience. J Am Coll Surg, 216(1), 41–49. https://doi.org/10.1016/j.jamcollsurg.2012.08.030
Wolf, Patrick S., James O. Park, Fei Bao, Peter J. Allen, Ronald P. DeMatteo, Yuman Fong, William R. Jarnagin, et al. “Preoperative chemotherapy and the risk of hepatotoxicity and morbidity after liver resection for metastatic colorectal cancer: a single institution experience.J Am Coll Surg 216, no. 1 (January 2013): 41–49. https://doi.org/10.1016/j.jamcollsurg.2012.08.030.
Wolf, Patrick S., et al. “Preoperative chemotherapy and the risk of hepatotoxicity and morbidity after liver resection for metastatic colorectal cancer: a single institution experience.J Am Coll Surg, vol. 216, no. 1, Jan. 2013, pp. 41–49. Pubmed, doi:10.1016/j.jamcollsurg.2012.08.030.
Wolf PS, Park JO, Bao F, Allen PJ, DeMatteo RP, Fong Y, Jarnagin WR, Kingham TP, Gönen M, Kemeny N, Shia J, D’Angelica MI. Preoperative chemotherapy and the risk of hepatotoxicity and morbidity after liver resection for metastatic colorectal cancer: a single institution experience. J Am Coll Surg. 2013 Jan;216(1):41–49.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

January 2013

Volume

216

Issue

1

Start / End Page

41 / 49

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Oxaliplatin
  • Organoplatinum Compounds
  • Neoadjuvant Therapy
  • Multivariate Analysis
  • Middle Aged