Open Access, Peer-reviewed
pISSN 2288-6575
eISSN 2288-6796
    J Korean Surg Soc. 2011 Jan;80(1):36-42. Korean.
    Published online Jan 28, 2011.
    https://doi.org/10.4174/jkss.2011.80.1.36
    Copyright © 2011 The Korean Surgical Society
    Original Article

    Is Preoperative Chemotherapy Safe for Patients with Colorectal Liver Metastases Undergoing Metastasectomy?

    Ji Min Park, M.D., Bong Wan Kim, M.D., Young Bae Kim, M.D.,1 Jae Yeon Seok, M.D.,1 Ok Joo Paek, M.D., Seung Yeop Oh, M.D. and Kwang Wook Suh, M.D.
      • Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
      • 1Department of Pathology, Ajou University School of Medicine, Suwon, Korea.
    • Corresponding author (Email: suhkw@ajou.ac.kr )
    Received October 04, 2010; Accepted December 17, 2010.

    Abstract

    Purpose

    Controversies regarding preoperative versus postoperative chemotherapy for patients having hepatic metastases of colorectal primary made us elucidate the safety of chemotherapy. By examining the histopathologic changes in the liver following preoperative chemotherapy and analyzing the relation between surgical outcomes and preoperative chemotherapy, we were able to answer whether preoperative chemotherapy is safe.

    Methods

    We analyzed 38 patients who underwent chemotherapy before resection of hepatic metastasis from colorectal primary, retrospectively. Types of chemotherapy regimen were FL (5-FU+leucovorin), FOLFOX4 (oxaliplatin+5-FU+leucovorin), and FOLFIRI (irinotecan+5-FU+leucovorin). Results of liver function tests were compared before and after preoperative chemotherapy. One pathologist reviewed the degree of hepatic injury from resected specimens. Associations between the histological findings of hepatic injury and surgical outcomes and chemotherapeutic agents were examined.

    Results

    Histopathologic analysis revealed severe liver injury was present in 12 patients (31.6%). In further detail, moderate to severe sinusoidal dilatation was found in 3 patients (25%), steatosis of more than 30% was identified in 9 patients (75%), and steatohepatitis Kleiner score of ≥4 in 5 patients (41.7%). Preoperative chemotherapy did not affect the biochemical profiles of liver function. The overall perioperative complication rate was 5.3% (n=2). There was no difference in postoperative morbidity or mortality from reported results following hepatectomy.

    Conclusion

    We found preoperative chemotherapy definitely induced histopathologic changes of hepatotoxicities. Even so, preoperative chemotherapy did not increase morbidity or mortality after hepatic metastasectomy. Preoperative chemotherapy seems to be safe in performing curative hepatic resection for the metastases.

    Keywords
    Chemotherapy; Colon cancer; Metastasis

    Figures

    Fig. 1
    Examples of the liver injury. (A) Sinusoidal dilatation. Moderate centrilobular sinusoidal distention is observed in a patient who received oxaliplatin, and the hepatic cords are atrophic due to the dilated sinusoids (H&E stain, ×400). (B) Moderate steatosis. Macrovesicular and microvesicular steatosis is observed in the hepatic lobule over a half of the area (H&E stain, ×400). (C) Steatohepatitis. The hepatocytes show ballooning degeneration, lobular inflammation, macrovesicular and microvesicular steatosis (Kleiner score 5) (H&E stain, ×400).

    Tables

    Table 1
    Relationship between chemotherapy regimen and severe liver injury

    Table 2
    Types of postoperative complication

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    MeSH Terms
    Colonic Neoplasms
    Dilatation
    Fatty Liver
    Humans
    Liver
    Liver Function Tests
    Metastasectomy
    Neoplasm Metastasis
    Retrospective Studies
    Metrics
    Share
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