Sinusoidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy
Sinusoidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy
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DOI：
10.1097/sla.0b013e31815774de
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发表时间：
2008-01-01
影响因子：
9
通讯作者：
Jaeck, Daniel
中科院分区：
文献类型：
--
作者：
Nakano, Hiroshi;Oussoultzoglou, Elie;Jaeck, Daniel
目的：探讨肝窦损伤(SI)是否与结直肠肝转移瘤(CRLM)患者肝切除术后预后不良有关。背景：新近研究表明，肝窦损伤与以奥沙利铂为基础的化疗(OBC)在CRLM患者中存在相关性。然而，SI是否影响肝切除后的肝储备功能和预后尚不完全清楚。患者和方法：2003-2005年间，90例CRLM患者在术前化疗后接受了选择性肝切除。切除标本的非肿瘤性肝实质经病理证实为SI，并对这些患者的围手术期资料进行评估。结果：OBC与SI的发生率显著相关。术前15分钟吲哚青绿滞留率(ICG-R15)和术后总胆红素值明显高于对照组。在出现SI的患者中，住院时间显著延长。多因素分析显示，女性、OBC用药6个周期或以上、术前天冬氨酸氨基转移酶异常值36IU/L、术前ICG-R15值异常者(>；10%)与术前SI显著相关。在接受肝大部切除术的患者中，SI与较高的发病率和较长的住院时间显著相关。结论：本研究提示SI导致较差的肝脏储备和较高的并发症发生率。因此，女性患者接受6个周期或以上的OBC。或出现术前天冬氨酸氨基转移酶和ICG-R15值异常时，应慎重选择，然后再进行大范围肝切除术。
Objective: To investigate whether sinusoidal injury (SI) was associated with a worse outcome after hepatectomy in patients with colorectal liver metastases (CRLM).Background: Correlation between SI and oxaliplatin-based chemotherapy (OBC) was recently shown in patients with CRLM. However, it has yet to be fully clarified whether SI affects liver functional reserve and outcome after hepatectomy.Patients and Methods: Between 2003 and 2005, 90 patients with CRLM who underwent an elective hepatectomy after preoperative chemotherapies were included. Diagnosis of SI was established pathologically in the nontumoral liver parenchyma of the resected specimens, and perioperative data were assessed in these patients.Results: OBC was significantly associated with a higher incidence of SI. Preoperative indocyanine green retention rate at 15 minutes (ICG-R15) and postoperative value of total-bilirubin were significantly higher. and hospital stay was significantly longer in patients presenting with SI. Multivariate analysis showed that female gender, administration of 6 cycles or more of OBC, abnormal value of preoperative aspartate aminotransferase > 36 IU/L, or abnormal value of preoperative ICG-R15 (> 10%) were preoperative factors significantly associated with SI. Among patients undergoing a major hepatectomy, SI was significantly associated with higher morbidity and longer hospital stay.Conclusion: The present study suggests that SI resulted in a poorer liver functional reserve and in a higher complication rate after major hepatectomy. Therefore, female patients who received 6 cycles or more of OBC. or presenting with abnormal preoperative aspartate aminotransferase and ICG-R15 values should be carefully selected before deciding to undertake a major hepatectomy.