Evaluation of the potential association of preoperative chemotherapy with steatohepatitis in surgical patients with hepatic colorectal metastases

Abstract

e15009 Background: The treatment of hepatic colorectal cancer metastases is increasingly multi-modal. Preoperative chemotherapy may be associated with steatohepatitis, which may increase morbidity in patients undergoing resection. Our objective was to determine if preoperative chemotherapy is associated with steatohepatitis and to determine which agents confer the greatest risk. Materials and Methods: 149 patients who had undergone liver resection or biopsy for hepatic colorectal cancer metastases were identified from an institutional database. Surgical specimens were assessed for percent steatosis and the presence of steatohepatitis as defined by the Kleiner score. The medical record was reviewed for details of preoperative chemotherapy and post-operative course. The association of preoperative chemotherapy with steatosis and steatohepatitis was assessed. Preoperative non-contrast CT scans were reviewed for evidence of steatosis as determined by the radiographic liver/spleen (L/S) ratio. The association of the L/S ratio with the presence of steatohepatitis was determined. Post-operative outcome was compared in patients with and without steatohepatitis. Results: The mean age of the population was 60.8 ±11.6 years, 56% of patients were male, and 37% of patients received preoperative chemotherapy. Steatohepatitis was identified in 45.7% of specimens. There was no statistically significant difference in the rate of steatohepatitis (59% vs. 50%, p=0.49) or percent steatosis (37% vs. 32%, p=0.29) with or without preoperative chemotherapy. No individual agent predicted a greater risk of steatohepatitis or a greater degree of steatosis. There was no significant difference in the L/S ratio in patients with or without steatohepatitis (p=NS). In patients undergoing liver resection, there was no difference in total ICU stay, blood loss, total surgery time or total length of stay between the steatohepatitis and non-steatohepatitis groups. Conclusions: Although steatohepatitis remains a potential complication of systemic chemotherapy in surgical patients with hepatic colorectal metastases, the risk and impact of chemotherapy associated steatohepatitis have not been significant in our patient population. No significant financial relationships to disclose.