Hypertrophy of the non-embolized liver after chemotherapy
Hypertrophy of the non-embolized liver after chemotherapy
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DOI：
10.1111/j.1477-2574.2009.00004.x
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发表时间：
2009-03-01
期刊：
影响因子：
2.9
通讯作者：
Lapointe, Real W.
中科院分区：
文献类型：
--
作者：
Nafidi, Otmane;Desy, Delphine;Lapointe, Real W.
背景：新辅助化疗(NC+)和门静脉栓塞术(PVE)可以使更多的结直肠肝转移(CRLM)患者获得根治性切除。然而，在NC+后，有报道称结构改变有术后肝功能衰竭的风险。方法：20例患者接受了PVE，其中13例(65%)接受了平均6.6周期的FOLFIRI(5-氟尿嘧啶+亚叶酸钙+伊立替康)方案化疗。结果：CRLM69%(NC+)和57%(NC-)为双侧，84%(NC+)和14%(NC-)同步。FRL肥大率NC+组为54.1%，NC-组为43.7%(P=0.3)。在我们的20例患者中，有4例CRLM无法切除，即NC+组：1例FRL肥大不足和1例严重脂肪变性；NC-组：2例肿瘤进展。两组手术参数除椎弓根夹闭时间分别为8分钟(NC+)和36分钟(NC-)外，差异均有统计学意义(P<；0.05)。此外，手术转化率和住院天数也具有可比性。两组间无明显病理差异。两组均无死亡。结论：鉴于我们有限的经验，我们得出结论，基于FOLFIRI的NC后，非栓塞性肝脏肥大(FRL)没有改变。
Background: Neoadjuvant chemotherapy (NC+) and portal vein embolization (PVE) enables curative resection in more patients with colorectal-liver metastases (CRLM). However, after NC+, structural alterations have been reported with the risk of post-operative hepatic failure. We undertook to determine if NC+ toxicity limits future remnant liver (FRL) hypertrophy after PVE.Methods: PVE was performed in 20 patients, 13 (65%) of whom previously received a mean FOLFIRI (5-fluorouracil + leucovorin + irinotecan) regimen (NC+) of 6.6 cycles. The seven remaining patients served as the control group without NC (NC-).Results: CRLM were bilateral in 69% (NC+) and 57% (NC-), and synchronous in 84% (NC+) and 14% (NC-). The FRL hypertrophy rate was 54.1% (NC+) and 43.7% (NC-) (P = 0.3). CRLM were unresectable in four of our 20 patients, i.e. group NC+: one insufficient FRL hypertrophy and one severe steatosis; and group NC-: two tumoral progressions. In both groups, the operative parameters were comparable except for pedicular clamping: 8 (NC+) and 36 min (NC-), respectively (P < 0.05). Also, the surgical outcome rate and hospital stay were comparable. No significant pathological difference was observed between the two groups. No mortality occurred in either group.Conclusion: In view of our limited experience, we conclude that hypertrophy of the non-embolized liver (FRL) is not altered after FOLFIRI-based NC.