Chemotherapy and Hepatic Steatosis: Impact on Postoperative Morbidity and Survival after Liver Resection for Colorectal Liver Metastases

Abstract

<b><i>Background:</i></b> Hepatic steatosis and chemotherapy in the treatment of colorectal liver metastases (CLM) are often linked to increased mortality and morbidity after liver resection. This study evaluates the influence of macrovesicular hepatic steatosis and chemotherapeutic regimes on graded morbidity and mortality after liver resection for CLM. <b><i>Methods:</i></b> A total of 323 cases of liver resection for CLM were retrospectively analysed using univariable and multivariable linear, ordinal and Cox regression analyses. The resected liver tissue was re-evaluated by a single observer to determine the grade and type of hepatic steatosis. <b><i>Results:</i></b> Macrovesicular steatosis did not influence postoperative morbidity and survival, as evidenced by risk-adjusted multivariable Cox regression analysis (<i>p</i> = 0.521). Conversion chemotherapy containing oxaliplatin was an independent and significant risk factor for mortality in risk-adjusted multivariable Cox regression analysis (<i>p</i> = 0.005). Identified independently, significant risk factors for postoperative morbidity were neoadjuvant treatment of metastases of the primary tumour with irinotecan (<i>p</i> = 0.003), the duration of surgery in minutes (<i>p</i> = 0.001) and the number of intraoperatively transfused packed red blood cells (<i>p</i> ≤ 0.001). Surprisingly, macrovesicular hepatic steatosis was not a risk factor for postoperative morbidity and was even associated with lower rates of complications (<i>p</i> = 0.006). <b><i>Conclusion:</i></b> The results emphasize the multifactorial influence of preoperative liver damage and chemotherapy on the severity of postoperative morbidity, as well as the significant impact of conversion chemotherapy containing oxaliplatin on survival.

The impact of hepatic steatosis on outcomes of colorectal cancer patients with liver metastases: A systematic review and meta-analysis

“…The proportion of male patients ranged from 32.2 to 70.1%. Three studies ( 20 – 22 ) did not report data on the use of neoadjuvant chemotherapy. Only one study ( 15 ) reported data on body mass index (BMI) in the study and control groups.…”

“…Of the 16 studies selected for full-text analysis, seven studies were excluded with reasons. A total of nine studies fulfilled the eligibility criteria and were included in this review (12)(13)(14)(15)(18)(19)(20)(21)(22).…”

“…In the case of resectable disease, the therapy can lower the burden of metastases and improve surgical outcomes ( 13 ). However, chemotherapy itself is associated with liver injuries ranging from sinusoidal obstruction syndrome lesion, nodular regenerative hyperplasia, steatosis, and steatohepatitis which in turn can potentially worsen surgical morbidity and mortality ( 20 ). However, liver injuries with chemotherapy are regimen-specific.…”

“…The proportion of male patients ranged from 32.2 to 70.1%. Three studies(20)(21)(22) did not report data on the use of neoadjuvant chemotherapy.…”