Karoui M, Penna C, Amin-Hashem M, Mitry E, Benoist S, Franc B, Rougier P, Nordlinger BInfluence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 243: 1-7

Departments of Surgery, Hôpital Ambroise Paré, Boulogne, France.
Annals of Surgery (Impact Factor: 8.33). 02/2006; 243(1):1-7. DOI: 10.1097/01.sla.0000193603.26265.c3
Source: PubMed


: To assess the effects of preoperative systemic chemotherapy on remnant liver parenchyma, liver function, and morbidity after major liver resection for colorectal liver metastases.
: Many patients operated upon for colorectal cancer liver metastases receive previous chemotherapy. Whether systemic chemotherapy alters liver parenchyma in such way that it increases the risks of liver resection remains unclear.
: Among 214 patients who received a liver resection for colorectal liver metastases between 1998 and 2002 in a single institution, 67 who underwent a major liver resection under total hepatic vascular exclusion form the basis of this report. Forty-five patients operated upon after systemic chemotherapy were compared with 22 who did not receive any chemotherapy in the 6 months prior to resection. Postoperative mortality, morbidity, liver function tests, and pathology of the resected liver in the two groups were compared.
: There was no postoperative mortality. Values of liver function tests on days 1, 3, 5, and 10 were similar in both groups. Morbidity rate was higher in the chemotherapy group (38% versus 13.5%, P = 0.03). Postoperative morbidity was correlated with the number of cycles of chemotherapy administered before surgery but not to the type of chemotherapy. Preoperative chemotherapy was significantly associated with sinusoidal dilatation, atrophy of hepatocytes, and/or hepatocytic necrosis (49% versus 25%, P = 0.005).
: Prolonged neoadjuvant systemic chemotherapy alters liver parenchyma and increases morbidity after major resection under total hepatic vascular exclusion, but it does not increase operative mortality. This should be taken into consideration before deciding a major liver resection in patients who have received preoperative chemotherapy.

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Available from: Stephane Benoist, Aug 28, 2015
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    • "This procedure removes the most functioning liver (5 or 6 segments) of all liver resections and exposes patients to a significant risk of posthepatectomy liver failure (PHLF), which is associated with a high mortality, especially when complicated by renal dysfunction [2]. The reported incidence of PHLF after extended right hepatectomy is between 1.2% and 32% in published series [3] [4] [5] [6] [7] [8] [9] [10]. Lactic acid produced during anaerobic metabolism is cleared by the liver [11] and hyperlactataemia has been shown to predict postoperative liver dysfunction [12]. "
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    ABSTRACT: Introduction. Reducing the volume of resected liver parenchyma may lead to lower morbidity and mortality. The aim of this study was to determine whether partial preservation of segment IV leads to improved outcomes when undertaking extended right hepatectomy for colorectal liver metastases (CRLM). Materials and Methods. A retrospective analysis of patients undergoing right-sided hepatectomy for CRLM was performed. Rates of 90-day mortality and organ dysfunction were compared in 117 patients undergoing right hepatectomy (n = 85), partially extended right hepatectomy with preservation of part of segment IV (n = 20), and fully extended right hepatectomy (n = 12). Results. The 90-day mortality rate of those undergoing right hepatectomy (3/85) was similar to that of those undergoing extended right hepatectomy (0/12) (P = 1.000) but lower than that of those undergoing partially extended right hepatectomy (4/20) (P = 0.024). The rates of hepatic and renal dysfunction were similar between patients undergoing right hepatectomy, partially extended or extended hepatectomy. Discussion. Preservation of part of segment IV confers little clinical benefit when performing extended right hepatectomy for CRLM.
    Full-text · Article · Dec 2013 · HPB Surgery
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    • "Despite advances in both operative technique and perioperative care liver resection is associated with mortality rates of 0 to 22% (median 3.7%) and morbidity rates of 12.5% to 66% (median 36%) [1] including liver [2] [3] and renal dysfunction [4]. Liver dysfunction is a major contributor to both morbidity and mortality with an incidence between 1.2% and 32% in published series [5] [6] [7] [8] [9] [10] [11] [12]. Renal dysfunction has also been shown to be associated with mortality following liver resection [13], with a reported incidence between 5 and 15% [4] [14]. "
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    ABSTRACT: Introduction. The aim of this study was to assess the interaction of liver and renal dysfunction as risk factors for mortality after liver resection. Materials and Methods. A retrospective analysis of 501 patients undergoing liver resection in a single unit was undertaken. Posthepatectomy liver failure (PHLF) was defined according to the International Study Group of Liver Surgery (ISGLS) definition (assessed on day 5) and renal dysfunction according to RIFLE criteria. 90-day mortality was recorded. Results. Twenty-three patients died within 90 days of surgery (4.6%). The lowest mortality occurred in patients without evidence of PHLF or renal dysfunction (2.7%). The mortality rate in patients with isolated PHLF or renal dysfunction was 20% compared to 45% in patients with both. Diabetes (P = 0.028), renal dysfunction (P = 0.030), and PHLF on day 5 (P = 0.011) were independent predictors of 90-day mortality. Discussion. PHLF and postoperative renal dysfunction are independent predictors of 90-day mortality following liver resection but the predictive value for mortality is significantly higher when failure of both organ systems occurs simultaneously.
    Full-text · Article · Nov 2013 · HPB Surgery
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    • "Factors associated with peri-operative complications and death include patient age [7,8] and gender [9,10], hospital annual number of liver resections undertaken [9,11], pathologic origin of liver tumour [9,11], pre-operative liver and renal dysfunction [8,10], diabetes [12,13], chronic liver disease [7,9], and the peripheral neutrophil to lymphocyte ratio (NLR) [14]. Operative factors associated with outcome include blood loss [8,10] and transfusion [15,16], extent of liver resection [15,17], duration of surgery [18], simultaneous extrahepatic procedures [15,19], and the use of the Pringle manoeuvre [16,20]. "
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    ABSTRACT: The aim of this study was to determine if the post-operative serum arterial lactate concentration is associated with mortality, length of hospital stay or complications following hepatic resection. Serum lactate concentration was recorded at the end of liver resection in a consecutive series of 488 patients over a seven-year period. Liver function, coagulation and electrolyte tests were performed post-operatively. Renal dysfunction was defined as a creatinine rise of >1.5x the pre-operative value. The median lactate was 2.8 mmol/L (0.6 to 16 mmol/L) and was elevated (≥2 mmol/L) in 72% of patients. The lactate concentration was associated with peak post-operative bilirubin, prothrombin time, renal dysfunction, length of hospital stay and 90-day mortality (P < 0.001). The 90-day mortality in patients with a post-operative lactate ≥6 mmol/L was 28% compared to 0.7% in those with lactate ≤2 mmol/L. Pre-operative diabetes, number of segments resected, the surgeon's assessment of liver parenchyma, blood loss and transfusion were independently associated with lactate concentration. Initial post-operative lactate concentration is a useful predictor of outcome following hepatic resection. Patients with normal post-operative lactate are unlikely to suffer significant hepatic or renal dysfunction and may not require intensive monitoring or critical care.
    Full-text · Article · Oct 2013
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