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

Abstract

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.

Neoadjuvant chemotherapy does not impair liver regeneration following hepatectomy or portal vein embolization for colorectal cancer liver metastases

“…According to the authors, the fact that prolonged period of chemotherapy (median of nine cycles) was used in the study could account for this discrepancy. Similarly, preoperative chemotherapy before major hepatectomy in another study resulted in a negative effect on the post-resectional liver volume; the authors explained this by the inclusion of major liver resections only in the study, which are suggested to yield differences in regeneration [19]. However, the fact that preoperative chemotherapy in our study resulted in significant liver regeneration despite the strict inclusion of major liver resections does not support their hypothesis.…”

“…The results reported from these studies have mostly concluded that neoadjuvant chemotherapy does not have a negative impact on liver regeneration; however, these studies included relatively small sample size, ranging between 20 and 112 patients. Sturesson et al have shown that preoperative chemotherapy negatively affects postoperative and post-embolization liver regeneration [19,20], although it has also been concluded in several studies that neoadjuvant chemotherapy may not hinder Peter Metrakos and Mazen Hassanain contributed equally as senior authors. This manuscript was presented as a Long Oral Presentation at the Americas Hepatopancreatobiliary Association Meeting in Miami, FL, on March 13th 2014. liver hypertrophy in patients undergoing hepatectomy or PVE [21][22][23][24][25][26].…”

Tumour growth after portal vein embolization with pre-procedural chemotherapy for colorectal liver metastases

“…Baseline patient characteristics were collected retrospectively by reviewing patients' charts. Liver and tumour volumes were calculated from CT transversal plane images . Analyses were carried out to compare tumour progress between the right and the left lobe, thereby comparing tumour progress between the embolized and non‐embolized liver lobe.…”

“…Liver and tumour volumes were calculated from CT transversal plane images. 17,18 Analyses were carried out to compare tumour progress between the right and the left lobe, thereby comparing tumour progress between the embolized and non-embolized liver lobe. Data on the rightsided tumors were compared with data on the left-sided tumours within the entire population of both patients with bilobar disease, as well as those with unilobar metastases.…”

Impact of Neoadjuvant Chemotherapy on Hypertrophy of the Future Liver Remnant after Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy

“…While some authors report impaired hypertrophy of the FLR because of neoadjuvant CTx [21,22], others did not observe this adverse effect [23,24]. Recently, Shindoh et al found that preoperative CTx for more than 12 weeks increased the risk of postoperative hepatic insufficiency after extended right hepatectomy significantly and suggests to preserve at least 30% of FLR in such cases [25].…”