Liver Surgery and Transplant Unit, Department of Surgery, Institut de Malalties Digestives i Metabòliques Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain.
World J Surg Oncol. 2017 Dec 16;15(1):224. doi: 10.1186/s12957-017-1290-5.
New systemic chemotherapy agents have improved prognosis in patients with colorectal liver metastases (CLM), but some of them damage the liver parenchyma and ultimately increase postoperative morbidity and mortality after liver resection. The aims of our study were to determine the degree of hemodynamic and pathological liver injury in CLM patients receiving preoperative chemotherapy and to identify an association between these injuries and postoperative complications after liver resection.
This is a prospective descriptive study of patients with CLM receiving preoperative chemotherapy before curative liver resection from November 2013 to June 2014. All patients had preoperative elastography and hepatic hemodynamic evaluation. We analyzed clinical preoperative data and postoperative outcomes after grouping the patients by chemotherapy type, development of sinusoidal obstructive syndrome (SOS), and development of major complications.
Eleven from the 20 patients included in the study received preoperative oxaliplatin-based chemotherapy (OBC). Nine patients had SOS at pathological analysis and five patients developed major complications. Patients receiving preoperative OBC had higher values of hepatic venous pressure gradient (HVPG) and developed more SOS and major complications. Patients developing SOS had higher values of HVPG and developed more major complications. Patients with major complications had higher values of HVPG, and patients with a HVPG of 5 mmHg or greater had more major complications than those under 5 mmHg (20 vs 80%, p = 0.005).
OBC and SOS impair liver hemodynamics in CLM patients. An increase in major complications after liver resection in these patients develops at subclinical HVPG levels.
新的系统化疗药物改善了结直肠癌肝转移（CLM）患者的预后，但其中一些药物会损害肝实质，最终增加肝切除术后的发病率和死亡率。我们的研究目的是确定接受术前化疗的 CLM 患者的肝血流动力学和病理损伤程度，并确定这些损伤与肝切除术后并发症之间的关系。
这是一项前瞻性描述性研究，纳入了 2013 年 11 月至 2014 年 6 月期间接受根治性肝切除术前化疗的 CLM 患者。所有患者均接受术前弹性成像和肝血流动力学评估。我们根据化疗类型、是否发生窦阻塞综合征（SOS）和是否发生主要并发症对患者进行分组，分析了临床术前数据和术后结果。
研究纳入的 20 例患者中有 11 例接受了术前奥沙利铂为基础的化疗（OBC）。9 例患者在病理分析时发生 SOS，5 例患者发生主要并发症。接受术前 OBC 的患者 HVPG 值更高，且更易发生 SOS 和主要并发症。发生 SOS 的患者 HVPG 值更高，且更易发生主要并发症。发生主要并发症的患者 HVPG 值更高，HVPG 值为 5mmHg 或更高的患者比 HVPG 值低于 5mmHg 的患者更易发生主要并发症（20%比 80%，p=0.005）。
OBC 和 SOS 会损害 CLM 患者的肝血流动力学。这些患者在亚临床 HVPG 水平下，肝切除术后的主要并发症发生率增加。
