Hypertrophy of the non-embolized liver after chemotherapy

Abstract

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. © 2009 International Hepato-Pancreato-Biliary Association.