Patients with colorectal cancer that has spread to the liver have worse survival after liver surgery if they have a condition known as steatohepatitis (fatty inflammation of the liver). These results were published in the Journal of Clinical Oncology.
Colorectal cancer is the second leading cause of cancer-related deaths in the U.S. Metastatic colorectal refers to cancer that has spread from its site of origin to distant sites in the body. For patients with colorectal cancer that has spread to the liver, surgery to remove the liver metastases is sometimes possible.
Patients with liver metastases sometimes receive preoperative chemotherapy. Preoperative chemotherapy may reduce the size of liver tumors prior to surgery, and also provides information about a patient’s response to chemotherapy. Because some chemotherapy regimens can damage the liver, however, it’s possible that preoperative chemotherapy could affect the outcome of subsequent liver surgery.
To evaluate the effect of preoperative chemotherapy on the liver and on outcomes after liver surgery, researchers in the U.S. and Italy conducted a study among 406 patients. All patients had colorectal cancer and underwent surgery for the treatment of liver metastases. Sixty-one percent of patients received chemotherapy prior to liver surgery.
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- Patients who received a chemotherapy regimen that included oxaliplatin were more likely to develop sinusoidal dilation (swelling of blood vessels in the liver) than patients who did not receive any chemotherapy.
- Patients who received a chemotherapy regimen that included ironotecan were more likely to develop steatohepatitis (fatty inflammation of the liver) than patients who did not receive any chemotherapy.
- 14.7% of patients who had steatohepatitis died within 90 days of liver surgery compared to 1.6% of patients who did not have steatohepatitis.
The researchers conclude that patients who develop steatohepatitis before surgical removal of liver metastases have an increased risk of dying in the 90 days following surgery. Because the type of pre-operative chemotherapy may influence the likelihood of developing steatohepatitis, the researchers suggest that the type of chemotherapy regimen be carefully considered.
Reference: Vauthey J-N, Pawlik TM, Ribero D et al. Chemotherapy Regimen Predicts Steatohepatitis and an Increase in 90-Day Mortality After Surgery for Hepatic Colorectal Metastases. Journal of Clinical Oncology. 2006;24:2065-2072.
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