Splenic Enlargement Induced by Preoperative Chemotherapy Is an Useful Indicator for Predicting Liver Regeneration after Resection for Colorectal Liver Metastases

Abstract Background: Conversion chemotherapy may downsize unresectable colorectal liver metastases (CRLMs), but may cause liver injury and splenic enlargement. The effect of preoperative chemotherapy on liver regeneration after liver resection remains undetermined. The aim of this study was to examine whether splenic enlargement induced by preoperative chemotherapy is an indicator to identify high-risk patients for impaired liver regeneration and liver dysfunction after resection. Methods: We retrospectively reviewed 118 Japanese patients with CRLMs. Fifty one patients had conversion chemotherapy. The other 67 patients underwent upfront liver resection. We clarified effects of conversion chemotherapy on splenic volume, liver function, and postoperative liver regeneration. Perioperative outcome was also analyzed. Results: A ratio of the splenic volume before and after chemotherapy (SP index) in the oxaliplatin-based chemotherapy group was significantly greater than other chemotherapy groups after 9 or more chemotherapy cycles. Patients whose SP index was 1.2 or more had significantly higher indocyanine green retention rate at 15 min (ICG-R15) than patients without chemotherapy. Analyses of covariance showed liver regeneration rate after resection was decreased in patients whose SP index was 1.2 or more. The incidence of postoperative liver dysfunction in patients whose SP index was 1.2 or more was significantly greater than patients without chemotherapy. Multivariate analysis showed SP index was a significant predictive factor of impaired liver regeneration. Conclusions: Splenic enlargement induced by preoperative chemotherapy was a useful indicator for impaired liver regeneration after resection and a decision-making tool of treatment strategy for unresectable CRLMs.

Download Full-text

Preoperative Chemotherapy on Functional Liver Regeneration for Colorectal Liver Metastases Assessed With 99mTc-GSA SPECT/CT Imaging

International Surgery ◽

10.9738/intsurg-d-16-00209.1 ◽

2018 ◽

Vol 102 (9-10) ◽

pp. 431-439 ◽

Cited By ~ 1

Author(s):

Toru Beppu ◽

Hiromitsu Hayashi ◽

Morikatsu Yoshida ◽

Hidetoshi Nitta ◽

Katsunori Imai ◽

...

Keyword(s):

Liver Resection ◽

Liver Metastases ◽

Liver Regeneration ◽

Preoperative Chemotherapy ◽

Colorectal Liver Metastases ◽

Major Hepatectomy ◽

Liver Volume ◽

Control Group ◽

Remnant Liver ◽

Resection Rate

Objective: To investigate the functional liver regeneration after chemotherapy and liver resection for colorectal liver metastases (CRLM). Background/Purpose: Preoperative chemotherapy followed by liver resection for CRLM has been increasing; however, its negative impact on liver regeneration remains unknown. Methods: From January 2009 to December 2013, we enrolled 40 selected patients who underwent major hepatectomy without viral hepatitis and severe liver fibrosis. CRLM patients with preoperative chemotherapy (CT-CRLM group, n = 12) and patients without preoperative chemotherapy (control group, n = 28) were evaluated. Liver volume (LV) and functional liver volume (FLV) was assessed using Tc-99m–labeled galactosyl human serum albumin (99mTc-GSA) scintigraphy, single-photon emission computed tomography (SPECT), CT-fused images. Preoperative, future remnant liver, and post 1-month values were compared. Results: Median course of preoperative chemotherapy was 8 (range: 6–16). Preoperative background factors were almost identical including resection rate and functional resection rate. In the CT-CRLM group and in the control group, the percentage increases in LV were 39.3% ± 29.0% and 23.2% ± 23.5% (P = 0.037), and FLV were 79.4% ± 43.1% and 57.0% ± 33.4% (P = 0.417), respectively; absolute differences in LV were 216.2 ± 155.7 cm3 and 148.7 ± 134.7 cm3 (P = 0.086) and FLV were 19.4% ± 8.5%/m2 and 17.4% ± 7.9%/m2 (P = 0.235), respectively. We found no obvious tendency for negative influence on liver functional regeneration by the preoperative regimens for CRLM. Conclusions: Several courses of preoperative chemotherapy may not affect functional liver regeneration for CRLM patients after major hepatectomy.

Download Full-text

Usefulness of Contrast-Enhanced Intraoperative Ultrasonography (CE-IOUS) in Patients with Colorectal Liver Metastases after Preoperative Chemotherapy

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-012-2043-y ◽

2012 ◽

Vol 17 (2) ◽

pp. 281-287 ◽

Cited By ~ 27

Author(s):

Andrea Ruzzenente ◽

Simone Conci ◽

Calogero Iacono ◽

Alessandro Valdegamberi ◽

Tommaso Campagnaro ◽

...

Keyword(s):

Liver Metastases ◽

Preoperative Chemotherapy ◽

Colorectal Liver Metastases ◽

Intraoperative Ultrasonography ◽

Contrast Enhanced

Download Full-text

Immune Response Assessed by Flow-Cytometry and Immunhistochemistry is Linked to Pathological Response after Preoperative Chemotherapy in Patients Undergoing Resection for Colorectal Liver Metastases

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2019.11.234 ◽

2020 ◽

Vol 46 (2) ◽

pp. e96

Author(s):

Eckhard Klieser ◽

Florian Primavesi ◽

Stefan Stättner ◽

Peter Krenn ◽

Matthias Meissnitzer ◽

...

Keyword(s):

Flow Cytometry ◽

Immune Response ◽

Liver Metastases ◽

Preoperative Chemotherapy ◽

Colorectal Liver Metastases ◽

Pathological Response

Download Full-text

Histopathological growth patterns as biomarker for adjuvant systemic chemotherapy in patients with resected colorectal liver metastases

Clinical & Experimental Metastasis ◽

10.1007/s10585-020-10048-w ◽

2020 ◽

Vol 37 (5) ◽

pp. 593-605

Author(s):

Florian E. Buisman ◽

Eric P. van der Stok ◽

Boris Galjart ◽

Peter B. Vermeulen ◽

Vinod P. Balachandran ◽

...

Keyword(s):

New York ◽

Liver Metastases ◽

Preoperative Chemotherapy ◽

Colorectal Liver Metastases ◽

Systemic Chemotherapy ◽

Disease Free Survival ◽

Growth Patterns ◽

Cancer Center ◽

Pretreated Patients ◽

Histopathological Growth Patterns

Abstract Adjuvant systemic chemotherapy (CTx) is widely administered in patients with colorectal liver metastases (CRLM). Histopathological growth patterns (HGPs) are an independent prognostic factor for survival after complete resection. This study evaluates whether HGPs can predict the effectiveness of adjuvant CTx in patients with resected CRLM. Two main types of HGPs can be distinguished; the desmoplastic type and the non-desmoplastic type. Uni- and multivariable analyses for overall survival (OS) and disease-free survival (DFS) were performed, in both patients treated with and without preoperative chemotherapy. A total of 1236 patients from two tertiary centers (Memorial Sloan Kettering Cancer Center, New York, USA; Erasmus MC Cancer Institute, Rotterdam, The Netherlands) were included (period 2000–2016). A total of 656 patients (53.1%) patients received preoperative chemotherapy. Adjuvant CTx was only associated with a superior OS in non-desmoplastic patients that had not been pretreated (adjusted hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.37–0.73, p < 0.001), and not in desmoplastic patients (adjusted HR 1.78, 95% CI 0.75–4.21, p = 0.19). In pretreated patients no significant effect of adjuvant CTx was observed, neither in the desmoplastic group (adjusted HR 0.83, 95% CI 0.49–1.42, p = 0.50) nor in the non-desmoplastic group (adjusted HR 0.96, 95% CI 0.71–1.29, p = 0.79). Similar results were found for DFS, with a superior DFS in non-desmoplastic patients treated with adjuvant CTx (HR 0.71, 95% CI 0.55–0.93, p < 0.001) that were not pretreated. Adjuvant CTx seems to improve OS and DFS after resection of non-desmoplastic CRLM. However, this effect was only observed in patients that were not treated with chemotherapy.

Download Full-text

Complete Pathologic Response After Preoperative Chemotherapy for Colorectal Liver Metastases: Myth or Reality?

Journal of Clinical Oncology ◽

10.1200/jco.2007.13.7471 ◽

2008 ◽

Vol 26 (10) ◽

pp. 1635-1641 ◽

Cited By ~ 213

Author(s):

René Adam ◽

Dennis A. Wicherts ◽

Robbert J. de Haas ◽

Thomas Aloia ◽

Francis Lévi ◽

...

Keyword(s):

Liver Metastases ◽

Preoperative Chemotherapy ◽

Predictive Factors ◽

Colorectal Liver Metastases ◽

Objective Response ◽

Survival Rates ◽

Postoperative Mortality ◽

Pathologic Response ◽

High Survival ◽

Complete Pathologic Response

Purpose Complete clinical response (CCR) of colorectal liver metastases (CLM) following chemotherapy is of limited predictive value for complete pathologic response (CPR) and cure of the disease. The objective of this study was to determine predictive factors of CPR as well as its impact on survival. Patients and Methods From January 1985 to July 2006, 767 consecutive patients with CLM underwent liver resection after systemic chemotherapy. Patients with CPR were compared with patients without CPR. Results Twenty-nine of 767 (4%) patients had CPR, and none of these 29 patients had CCR. Patients with CPR (mean age, 54 years) had a mean number of 3.3 metastases at diagnosis (mean size, 29.3 mm). Objective response and stable disease were observed in 79% and 21% of cases, respectively. Postoperative mortality rate was 0%. After a median follow-up of 52.2 months (range, 1.1 to 193.0 months), overall 5-year survival was 76% for patients with CPR compared with 45% for patients without CPR (P = .004). Independent predictive factors for CPR were: age ≤ 60 years, size of metastases ≤ 3 cm at diagnosis, carcinoembryonic antigen (CEA) level at diagnosis ≤ 30 ng/mL, and objective response following chemotherapy. The probability of CPR ranged from 0.2% when all factors were absent to 30.9% when all were present. Conclusion CPR was observed in 4% of patients with CLM treated with preoperative chemotherapy. However, CPR may occur in almost one-third of objective responders age ≤ 60 years with metastases ≤ 3 cm and low CEA values. CPR is associated with uncommon high survival rates.

Download Full-text