Regenerative nodular hyperplasia (RNH) induced by oxaliplatin-based chemotherapy for colorectal liver metastases (CRLM): A contraindication for major liver resection?

Abstract

179 Background: Oxaliplatin is recognized to induce vascular lesions in the nontumoral liver parenchyma. Regenerative nodular hyperplasia (RNH), the ultimate state of the vascular lesions, is very rare. In some reported cases, RNH was associated with severe lethal postoperative complications after hepatic resection. This study aimed to compare the postoperative course after major hepatectomy, in patients with colorectal liver metastases treated with oxaliplatin-based chemotherapy, with or without RNH in the resected specimen. Methods: Between 2001 and 2009, among 420 patients who underwent liver resection for CRLM, 17 (4%) patients had RNH lesions (RNH+ group) on the resected specimen after right hepatectomy. These 17 patients were compared to another group of 20 patients with similar clinicopathologic data but without RNH (RNH- group) who underwent right hepatectomy. The mean age of the RNH + and RNH- groups was 57 years (range: 37-71 years) and 60 years (range: 43-73 years), respectively. Preoperatively the patients were treated with a mean number of 7 cycles of oxaliplatin (range: 3-12 cycles). The peroperative blood loss (560 vs. 830 ml) and blood transfusion (18% vs. 20%) were similar in the two groups. Results: The mortality in the RNH+ group and the RNH- group (6% vs. 5%, respectively) were similar (p>0.005). The postoperative morbidity was 53% in the RNH+ group and 35% in RNH– group (p>0.005). The most frequent complications were biliary fistula (3 in the RNH+ group and 2 in the RNH- group) and pulmonary complications (6 in the RNH+ group and 5 in the RNH- group). However, the post operative ascites was significantly encountered in the RNH+ group with 70% of patients compared with 40% in the RNH- group. The number of patients who had a bilirubin level at day 5 superior to 50 was significantly higher in the RNH+ group (35%) compared with 15% in the RNH-group. Conclusions: RNH lesions allow major hepatectomy without increased mortality but with increased postoperative ascites and jaundice justifying preoperative liver biopsy to detect this lesion with subsequent portal embolisation or sparing liver resection in order to avoid major resections. No significant financial relationships to disclose.