Khan Aamir Z, Morris-Stiff Gareth, Makuuchi Masatoshi
Royal Marsden Hospital, Fulham Road, London, UK.
J Hepatobiliary Pancreat Surg. 2009;16(2):137-44. doi: 10.1007/s00534-008-0016-z. Epub 2008 Dec 18.
Neoadjuvant chemotherapy is increasingly being used to enlarge the cohort of patients who can be offered hepatic resection for malignancy. However, the impact of these agents on the liver parenchyma itself, and their effects on clinical outcomes following hepatic resection remain unclear. This review identifies patterns of regimen-specific chemotherapy-induced hepatic injury and assesses their impact on outcomes following hepatic resection for colorectal liver metastases (CLM).
An electronic search was performed using the MEDLINE (US Library of Congress) database from 1966 to May 2007 to identify relevant articles related to chemotherapy-induced hepatic injury and subsequent outcome following hepatic resection.
The use of the combination of 5-flourouracil and leucovorin is linked to the development of hepatic steatosis, and translates into increased postoperative infection rates. A form of non-alcoholic steatohepatitis (NASH) related to chemotherapy and otherwise known as chemotherapy-associated steatohepatitis (CASH) is closely linked to irinotecan-based therapy and is associated with inferior outcomes following hepatic surgery mainly due to hepatic insufficiency and poor regeneration. Data on sinusoidal obstruction syndrome (SOS) following treatment with oxaliplatin are less convincing, but there appears to be an increased risk for intra-operative bleeding and decreased hepatic reserve associated with the presence of SOS. Intra-arterial floxuridine therapy damages the extrahepatic biliary tree in addition to causing parenchymal liver damage, and has been shown to be associated with increased morbidity after hepatic resection.
Agent-specific patterns of damage are now being recognized with increasing use of neoadjuvant chemotherapy prior to surgery. The potential benefits and risks of these should be considered on an individual patient basis prior to hepatic resection.
新辅助化疗越来越多地用于扩大可接受恶性肿瘤肝切除的患者群体。然而，这些药物对肝实质本身的影响以及它们对肝切除术后临床结局的作用仍不清楚。本综述确定了特定方案化疗所致肝损伤的模式，并评估了其对结直肠癌肝转移（CLM）肝切除术后结局的影响。
使用美国国会图书馆的MEDLINE数据库进行电子检索，检索时间跨度为1966年至2007年5月，以确定与化疗所致肝损伤及肝切除术后后续结局相关的文章。
5-氟尿嘧啶与亚叶酸联合使用与肝脂肪变性的发生有关，并导致术后感染率增加。一种与化疗相关的非酒精性脂肪性肝炎（NASH），也称为化疗相关性脂肪性肝炎（CASH），与基于伊立替康的治疗密切相关，并且与肝切除术后不良结局相关，主要原因是肝功能不全和再生不良。关于奥沙利铂治疗后窦性阻塞综合征（SOS）的数据不太有说服力，但SOS的存在似乎与术中出血风险增加和肝储备降低有关。肝动脉内氟尿苷治疗除了导致肝实质损伤外，还会损害肝外胆管树，并且已证明与肝切除术后发病率增加有关。
随着术前新辅助化疗的使用增加，现在已认识到特定药物的损伤模式。在进行肝切除术前，应根据个体患者情况考虑这些药物的潜在益处和风险。
