Nakano Hiroshi, Oussoultzoglou Elie, Rosso Edoardo, Casnedi Selenia, Chenard-Neu Marie-Pierre, Dufour Patrick, Bachellier Philippe, Jaeck Daniel
Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur, Avenue Molière, Strasbourg, France.
Ann Surg. 2008 Jan;247(1):118-24. doi: 10.1097/SLA.0b013e31815774de.
To investigate whether sinusoidal injury (SI) was associated with a worse outcome after hepatectomy in patients with colorectal liver metastases (CRLM).
Correlation between SI and oxaliplatin-based chemotherapy (OBC) was recently shown in patients with CRLM. However, it has yet to be fully clarified whether SI affects liver functional reserve and outcome after hepatectomy.
Between 2003 and 2005, 90 patients with CRLM who underwent an elective hepatectomy after preoperative chemotherapies were included. Diagnosis of SI was established pathologically in the nontumoral liver parenchyma of the resected specimens, and perioperative data were assessed in these patients.
OBC was significantly associated with a higher incidence of SI. Preoperative indocyanine green retention rate at 15 minutes (ICG-R15) and postoperative value of total-bilirubin were significantly higher, and hospital stay was significantly longer in patients presenting with SI. Multivariate analysis showed that female gender, administration of 6 cycles or more of OBC, abnormal value of preoperative aspartate aminotransferase >36 IU/L, or abnormal value of preoperative ICG-R15 (>10%) were preoperative factors significantly associated with SI. Among patients undergoing a major hepatectomy, SI was significantly associated with higher morbidity and longer hospital stay.
The present study suggests that SI resulted in a poorer liver functional reserve and in a higher complication rate after major hepatectomy. Therefore, female patients who received 6 cycles or more of OBC, or presenting with abnormal preoperative aspartate aminotransferase and ICG-R15 values should be carefully selected before deciding to undertake a major hepatectomy.
探讨在结直肠癌肝转移（CRLM）患者中，正弦波损伤（SI）是否与肝切除术后预后较差相关。
最近研究表明CRLM患者中SI与基于奥沙利铂的化疗（OBC）之间存在相关性。然而，SI是否影响肝切除术后的肝功能储备和预后尚未完全阐明。
纳入2003年至2005年间90例在术前化疗后接受择期肝切除术的CRLM患者。通过对切除标本的非肿瘤肝实质进行病理检查来确诊SI，并评估这些患者的围手术期数据。
OBC与SI的发生率显著相关。SI患者术前15分钟吲哚菁绿滞留率（ICG-R15）和术后总胆红素值显著更高，住院时间显著更长。多因素分析显示，女性、接受6个或更多周期的OBC、术前天冬氨酸转氨酶值异常>36 IU/L或术前ICG-R15值异常（>10%）是与SI显著相关的术前因素。在接受大肝切除术的患者中，SI与更高的发病率和更长的住院时间显著相关。
本研究表明，SI导致大肝切除术后肝功能储备较差且并发症发生率较高。因此，在决定进行大肝切除术之前，应仔细筛选接受6个或更多周期OBC的女性患者，或术前天冬氨酸转氨酶和ICG-R15值异常的患者。
