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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2011

01-02-2011 | Hepatobiliary Tumors

Sinusoidal Obstruction Syndrome Impairs Long-Term Outcome of Colorectal Liver Metastases Treated with Resection after Neoadjuvant Chemotherapy

Authors: Dietmar Tamandl, MD, Markus Klinger, MD, Sandra Eipeldauer, MD, Beata Herberger, BSc, Klaus Kaczirek, MD, Birgit Gruenberger, MD, Thomas Gruenberger, MD

Published in: Annals of Surgical Oncology | Issue 2/2011

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Abstract

Background

Chemotherapy-induced liver injury is a considerable problem in patients undergoing surgery for colorectal liver metastases, since an increase in postoperative morbidity and mortality has been observed. We investigated whether liver damage had further implications on long-term outcome in these patients.

Materials and Methods

Liver specimens from 196 patients resected for colorectal liver metastases were evaluated for chemotherapy-associated hepatic damage in the nontumorous liver. Injury patterns were correlated with recurrence free (RFS) and overall survival (OS). Factors leading to sinusoidal injury were identified.

Results

Patients who developed grade 2 or 3 sinusoidal dilatation had a significantly shorter RFS (hazard ratio [HR] 2.05; 95% confidence interval [95% CI] 1.23–3.39, P = .005) and OS (HR 2.90; 95% CI 1.61–6.19, P < .001), compared to patients without this alteration. Those patients also had significantly more intrahepatic recurrences (66.7% vs 30.5%, P = .003). Other patterns of chemotherapy-associated liver damage (nonalcoholic steatohepatitis, fibrosis) were not associated with impaired survival. Factors indicating sinusoidal injury were oxaliplatin-based chemotherapy, tumor size >5 cm, and elevated alkaline phosphatase or gamma glutamyltransferase.

Conclusions

Sinusoidal obstruction syndrome due to oxaliplatin-based chemotherapy may not only compromise perioperative outcome, but can lead to early recurrence and decreased survival in the long term. Strategies to prevent this condition are clearly needed.
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Metadata
Title
Sinusoidal Obstruction Syndrome Impairs Long-Term Outcome of Colorectal Liver Metastases Treated with Resection after Neoadjuvant Chemotherapy
Authors
Dietmar Tamandl, MD
Markus Klinger, MD
Sandra Eipeldauer, MD
Beata Herberger, BSc
Klaus Kaczirek, MD
Birgit Gruenberger, MD
Thomas Gruenberger, MD
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 2/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1317-4

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