Preoperative Chemotherapy May Not Influence the Remnant Liver Regenerations and Outcomes After Hepatectomy for Colorectal Liver Metastasis

Inoué, Yoshihiro; Fujii, Kensuke; Tashiro, Kunio; Ishii, Masatsugu; Masubuchi, Shinsuke; Yamamoto, Masashi; Shimizu, Tetsunosuke; Asakuma, Mitsuhiro; Hirokawa, Fumitoshi; Hayashi, Michihiro; Narumi, Y; Uchiyama, Kazuhisa

doi:10.1007/s00268-018-4590-1

Cited by 17 publications

(20 citation statements)

References 42 publications

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“…Furthermore, there was no significant difference in the frequency of repeat hepatectomy for recurrence due to insufficient regeneration of the remnant liver between patients with and without early recurrence. As the value of adjuvant chemotherapy after hepatectomy has yet to be established [25,26], the issue of resection feasibility in the event of early postoperative recurrence should be considered. Patients with CRC lymph node metastasis, synchronous liver metastasis, or multiple liver metastases require particularly careful surveillance in order to detect early recurrence.…”

Section: Discussionmentioning

confidence: 99%

The Management of Recurrence within Six Months after Hepatic Resection for Colorectal Liver Metastasis

et al. 2019

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Background: Hepatectomy is currently recommended as the most reliable treatment for colorectal liver metastases. However, the association between the choice of treatment for recurrence and the timing of recurrence remains controversial. Methods: Two-hundred ninety-five patients who underwent hepatectomy were retrospectively analyzed for the risk factors and the outcomes for early recurrence within 6 months. The remnant liver volumes (RLVs) and laboratory data were measured postoperatively using multidetector computed tomography on days 7 and months 1, 2, and 5 after the operation. Results: Early recurrence developed in 88/295 patients (29.8%). Colorectal cancer lymph node metastasis, synchronous liver metastasis, and multiple liver metastases were independent risk factors for the occurrence of early recurrence (p < 0.001, 0.032, and 0.019, respectively). Patients with early recurrence had a poorer prognosis than did patients who developed later recurrence (p < 0.001). Patients who underwent surgery or other local treatment had better outcomes. The changes in RLV and laboratory data after postoperative month 2 were not significantly different between the 2 groups. Conclusion: Patients with early recurrence within 6 months had a poorer prognosis than did patients who developed later recurrence. However, patients who underwent repeat hepatectomy for recurrence had a better prognosis than did those who underwent other treatments, with good prospects for long-term survival.

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Section: Discussionmentioning

confidence: 99%

The Management of Recurrence within Six Months after Hepatic Resection for Colorectal Liver Metastasis

et al. 2019

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“…In these cases, surgical resection alone may offer little benefit, and chemotherapy is the main therapeutic strategy for advanced patients 52 . However, the clinical benefits of liver metastasis chemotherapy are not always obvious and multiple chemotherapy leads to an additional burden of patients due to adverse effects 52,53 . Therefore, the therapeutic response of patients with liver metastasis and timely control of the progression of liver metastases are of great significance to improve the survival and clinical benefits of patients with liver metastasis.…”

Section: Discussionmentioning

confidence: 99%

Clinical application of thioredoxin reductase as a novel biomarker in liver cancer

Wang

et al. 2021

Sci Rep

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Hepatic cancer is often amenable to surgery, including percutaneous ablation, trans-arterial chemoembolization. However, in metastatic cases, surgery is often not an effective option. Chemotherapy as a conventional clinical method for treatment of malignant diseases may be useful in such cases, but it is likewise not always able to slow or halt progression, therefore novel approaches for treatment of hepatic cancer are needed. Current research suggests that molecular tumor markers (TM) can play a crucial role for diagnosis and prognostic evaluation of malignancies, and TM such as AFP, CEA, CA19-9 have been reported in many malignant diseases. Thioredoxin reductase (TrxR), a type of anti-oxidant biomarker, has become a TM of significant interest. However, little is known about the above TM and TrxR activity in liver cancer. Therefore, this paper aimed to assess these TM with regards to diagnosis and and monitoring treatment efficacy in both primary and metastatic liver cancer. Our results showed TrxR had superior performance for discriminating between liver cancer patients and healthy controls than AFP, CEA, and CA19-9. TrxR also exhibited superior performance for assessing benefits of chemotherapy regardless if patients had PLC or MLC. Meanwhile, due to diagnostic efficiency of unresponsive chemotherapy patients, TrxR also showed a higher activity levels than other general markers in liver metastasis patients. Our results suggest that application of TrxR in combination with other tumor markers may maximize the efficiency of diagnosis and assessment of therapeutic efficiency, and provide new insights for the clinical application of TrxR as a candidate biomarker for liver cancer.

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“…The influence of preoperative chemotherapy on liver regeneration after liver resection is still controversial. Although some reports showed that preoperative chemotherapy itself does not affect liver regeneration and post-operative course (23)(24)(25), few studies have argued the adverse effects of chemotherapy-induced hepatotoxicity on early liver regeneration after liver resection. Current study suggested that splenic enlargement which represents liver injury caused by chemotherapy is related to impaired liver regeneration after hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

Splenic Enlargement Induced by Preoperative Chemotherapy Is an Useful Indicator for Predicting Liver Regeneration after Resection for Colorectal Liver Metastases

Konishi

Yoshidome

Yoshitomi

et al. 2021

HPB

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Background: Conversion chemotherapy may downsize unresectable colorectal liver metastases (CRLMs), but may cause liver injury and splenic enlargement. The effect of preoperative chemotherapy on liver regeneration after liver resection remains undetermined. The aim of this study was to examine whether splenic enlargement induced by preoperative chemotherapy is an indicator to identify high-risk patients for impaired liver regeneration and liver dysfunction after resection. Methods: We retrospectively reviewed 118 Japanese patients with CRLMs. Fifty one patients had conversion chemotherapy. The other 67 patients underwent upfront liver resection. We clarified effects of conversion chemotherapy on splenic volume, liver function, and postoperative liver regeneration. Perioperative outcome was also analyzed. Results: A ratio of the splenic volume before and after chemotherapy (SP index) in the oxaliplatin-based chemotherapy group was significantly greater than other chemotherapy groups after 9 or more chemotherapy cycles. Patients whose SP index was 1.2 or more had significantly higher indocyanine green retention rate at 15 min (ICG-R15) than patients without chemotherapy. Analyses of covariance showed liver regeneration rate after resection was decreased in patients whose SP index was 1.2 or more. The incidence of postoperative liver dysfunction in patients whose SP index was 1.2 or more was significantly greater than patients without chemotherapy. Multivariate analysis showed SP index was a significant predictive factor of impaired liver regeneration. Conclusions: Splenic enlargement induced by preoperative chemotherapy was a useful indicator for impaired liver regeneration after resection and a decisionmaking tool of treatment strategy for unresectable CRLMs.

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Preoperative Chemotherapy May Not Influence the Remnant Liver Regenerations and Outcomes After Hepatectomy for Colorectal Liver Metastasis

Abstract: Preoperative chemotherapy may have no appreciable benefit for patients with CLM in terms of perioperative and long-term outcomes.

Cited by 17 publications

References 42 publications

The Management of Recurrence within Six Months after Hepatic Resection for Colorectal Liver Metastasis

The Management of Recurrence within Six Months after Hepatic Resection for Colorectal Liver Metastasis

Clinical application of thioredoxin reductase as a novel biomarker in liver cancer

Splenic Enlargement Induced by Preoperative Chemotherapy Is an Useful Indicator for Predicting Liver Regeneration after Resection for Colorectal Liver Metastases

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