Division of Hepatobiliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Saint-Luc University Hospital, Université Catholique de Louvain (UCL), Brussels, Belgium.
Surgery. 2010 Feb;147(2):185-94. doi: 10.1016/j.surg.2009.01.004.
Hepatotoxicity from neoadjuvant chemotherapy before liver resection for colorectal metastases (CRLM) has been recently reported. The purpose of the present study was to evaluate the prevalence and the clinical relevance of this phenomenon. It was a retrospective study conducted at an academic secondary referral hospital.
One hundred patients suffering from CRLM and having undergone the resection of at least 1 liver segment (114 hepatectomies; 100 first, 13 second, 1 third) were enrolled. The surgical specimens were reviewed using standardized criteria for diagnosis and grading of pathological liver changes. Their impact on perioperative bleeding, transfusion, morbidity, and mortality rates after liver resection was studied.
Sinusoidal congestion was the single hepatotoxic lesion significantly more frequently encountered in patients having received neoadjuvant chemotherapy (P = .0014), even in patients having received chemotherapy more than 6 months before liver resection, but was not related to the type of chemotherapy. Despite a significant increase in perioperative blood losses, the presence of sinusoidal lesions, even severe, had no clinically significant effect on postoperative mortality, morbidity, and transfusion rates.
Neoadjuvant chemotherapy before operation for CRLM is significantly associated to sinusoidal congestion, irrespective of the type of chemotherapy but without any significant impact on postoperative clinical outcome. Sinusoidal lesions may persist more than 6 months after the end of chemotherapy.
肝切除术治疗结直肠癌肝转移（CRLM）前新辅助化疗导致的肝毒性最近有报道。本研究的目的是评估这种现象的发生率和临床相关性。这是一项在学术性二级转诊医院进行的回顾性研究。
共纳入 100 例接受至少 1 个肝段切除术（114 例肝切除术；100 例首次手术，13 例二次手术，1 例三次手术）的 CRLM 患者。使用诊断和分级病理性肝改变的标准化标准对手术标本进行评估。研究其对肝切除术后围手术期出血、输血、发病率和死亡率的影响。
单纯性肝窦阻塞是新辅助化疗患者更常遇到的单一肝毒性病变（P =.0014），甚至在化疗结束 6 个月前接受化疗的患者中也是如此，但与化疗类型无关。尽管围手术期失血显著增加，但即使是严重的窦状病变对术后死亡率、发病率和输血率也没有明显的临床影响。
CRLM 患者术前新辅助化疗与肝窦阻塞显著相关，与化疗类型无关，但对术后临床结局无明显影响。窦状病变在化疗结束后可能持续 6 个月以上。
