Hypertrophy of the non-embolized liver after chemotherapy

Abstract

BackgroundNeoadjuvant 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. MethodsPVE 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−). ResultsCRLM 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 36min (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. ConclusionIn view of our limited experience, we conclude that hypertrophy of the non-embolized liver (FRL) is not altered after FOLFIRI-based NC.