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Optimal Future Liver Remnant in Patients Treated with Extensive Preoperative Chemotherapy for Colorectal Liver Metastases

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients with colorectal liver metastases (CLM) are increasingly treated with preoperative chemotherapy. Chemotherapy associated liver injury is associated with postoperative hepatic insufficiency (PHI) and mortality. The adequate minimum future liver remnant (FLR) volume in patients treated with extensive chemotherapy remains unknown.

Methods

All patients with standardized FLR > 20 %, who underwent extended right hepatectomy for CLM from 1993-2011, were divided into three cohorts by chemotherapy duration: no chemotherapy (NC, n = 30), short duration (SD, ≤12 weeks, n = 78), long duration (LD, >12 weeks, n = 86). PHI and mortality were compared by using uni-/multivariate analyses. Optimal FLR for LD chemotherapy was determined using a minimum p-value approach.

Results

A total of 194 patients met inclusion criteria. LD chemotherapy was significantly associated with PHI (NC + SD 3.7 vs. LD 16.3%, p = 0.006). Ninety-day mortality rates were 0 % in NC, 1.3 % in SD, and 2.3% in LD patients, respectively (p = 0.95). In patients with FLR > 30 %, PHI occurred in only two patients (both LD, 2/20, 10 %), but all patients with FLR > 30 % survived. The best cutoff of FLR for preventing PHI after chemotherapy >12 weeks was estimated as >30 %. Both LD chemotherapy (odds ratio [OR] 5.4, p = 0.004) and FLR ≤ 30 % (OR 6.3, p = 0.019) were independent predictors of PHI.

Conclusions

Preoperative chemotherapy >12 weeks increases the risk of PHI after extended right hepatectomy. In patients treated with long-duration chemotherapy, FLR > 30 % reduces the rate of PHI and may provide enough functional reserve for clinical rescue if PHI develops.

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Acknowledgment

The University of Texas MD Anderson Cancer Center is supported in part by the National Institutes of Health through Cancer Center Support Grant CA016672.

Conflicts of interest

Authors have no conflict of interest to disclose.

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Authors and Affiliations

  1. Department of Surgical Oncology, Unit 1484, The University of Texas MD Anderson Cancer Center, Houston, USA

    Junichi Shindoh MD, PhD, Ching-Wei D. Tzeng MD, Thomas A. Aloia MD, Steven A. Curley MD, Giuseppe Zimmitti MD, Steven H. Wei PA-C & Jean-Nicolas Vauthey MD

  2. Department of Diagnostic Radiology, Unit 1471, The University of Texas MD Anderson Cancer Center, Houston, USA

    Steven Y. Huang MD, Armeen Mahvash MD, Sanjay Gupta MD & Michael J. Wallace MD

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  1. Junichi Shindoh MD, PhD
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  2. Ching-Wei D. Tzeng MD
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  11. Jean-Nicolas Vauthey MD
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Correspondence to Jean-Nicolas Vauthey MD.

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Shindoh, J., Tzeng, CW.D., Aloia, T.A. et al. Optimal Future Liver Remnant in Patients Treated with Extensive Preoperative Chemotherapy for Colorectal Liver Metastases. Ann Surg Oncol 20, 2493–2500 (2013). https://doi.org/10.1245/s10434-012-2864-7

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  • DOI: https://doi.org/10.1245/s10434-012-2864-7

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