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01-08-2012 | Hepatobiliary Tumors

What Is a Safe Future Liver Remnant Size in Patients Undergoing Major Hepatectomy for Colorectal Liver Metastases and Treated by Intensive Preoperative Chemotherapy?

Authors: Masato Narita, MD, PhD, Elie Oussoultzoglou, MD, Pascal Fuchshuber, MD, PhD, FACS, Patrick Pessaux, MD, PhD, Marie-Pierre Chenard, MD, PhD, Edoardo Rosso, MD, Cinzia Nobili, MD, Daniel Jaeck, MD, PhD, Philippe Bachellier, MD, PhD

Published in: Annals of Surgical Oncology | Issue 8/2012

Abstract

Background

A multidisciplinary approach involving preoperative chemotherapy has become common practice in patients with colorectal liver metastases (CLM). The definition of a safe future liver remnant (FLR) volume based on preoperative clinical data in these patients is lacking. Our aim was to identify predictors of postoperative morbidities in patients undergoing major hepatectomy after intensive preoperative chemotherapy for CLM.

Methods

Between January 2000 and August 2010, a total of 101 consecutive patients with CLM underwent major hepatectomy after preoperative chemotherapy (≥6 cycles of oxaliplatin or irinotecan regimen with or without targeted therapies). The FLR ratio was calculated by two formulas: actual FLR (aFLR) ratio, and standardized FLR (sFLR) ratio. Predictors of postoperative overall morbidity, sepsis, and liver failure were identified by univariate and multivariate analyses.

Results

Fifty-eight patients (57.4%) had 95 postoperative complications. Sepsis and postoperative liver failure occurred in 23 (22.8%) and 16 patients (15.8%), respectively. On univariate analysis, small aFLR ratio was significantly associated with all complications, and sFLR ratio was associated with sepsis and liver failure. In receiver-operating characteristic analysis, the cutoff of aFLR ratio in predicting overall morbidity, sepsis, and liver failure was 44.8, 43.1, and 37.7%, respectively, and that of sFLR ratio in predicting sepsis and liver failure was 43.6 and 48.5%, respectively. On multivariate analysis, these aFLR and sFLR ratio cutoffs were independent predictors of all complications and of sepsis and liver failure, respectively.

Conclusions

This study provides a cutoff FLR ratio for safe postoperative outcome after major hepatectomy in CLM patients receiving six or more cycles of preoperative chemotherapy.

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Title: What Is a Safe Future Liver Remnant Size in Patients Undergoing Major Hepatectomy for Colorectal Liver Metastases and Treated by Intensive Preoperative Chemotherapy?
Authors: Masato Narita, MD, PhD
Elie Oussoultzoglou, MD
Pascal Fuchshuber, MD, PhD, FACS
Patrick Pessaux, MD, PhD
Marie-Pierre Chenard, MD, PhD
Edoardo Rosso, MD
Cinzia Nobili, MD
Daniel Jaeck, MD, PhD
Philippe Bachellier, MD, PhD
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 8/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2274-x

At a glance: The STEP trials

Springer Medicine

What Is a Safe Future Liver Remnant Size in Patients Undergoing Major Hepatectomy for Colorectal Liver Metastases and Treated by Intensive Preoperative Chemotherapy?

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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