Does Chemotherapy-Induced Liver Injury Impair Postoperative Outcomes After Laparoscopic Liver Resection for Colorectal Metastases?

Porto-sinusoidal vascular disorder in surgical candidates for liver metastases: Prevalence, noninvasive diagnosis, and burden on surgical outcomes

Chemotherapy can cause vascular and metabolic liver injury in patients with liver metastases, but scarce data are available. We aimed to (i) describe the prevalence of porto-sinusoidal vascular disorder (PSVD) among patients undergoing resection for liver metastases; and (ii) assess whether liver (LSM) and spleen stiffness measurements could diagnose PSVD and predict postoperative complications. This is a prospective single-center study enrolling consecutive patients undergoing hepatic resection for metastases at a tertiary center. For each patient, we evaluated previous exposure to chemotherapy, comorbidities, elastography, type of surgery, histological features at the resection specimen, morbidity (post-hepatectomy liver failure and major complications according to Clavien-Dindo), and 90-day survival. Sixty-eight patients were included, of whom 60 (88%) had received chemotherapy. Twenty-nine (44%) patients had PSVD. Spleen stiffness measurements <21 kPa (negative predictive value 87%) and >40 kPa (positive predictive value 100%) could accurately diagnose PSVD. PSVD significantly increased the risk of post-hepatectomy liver failure (22% vs. 45%) and major complications (11% vs. 31%). Preoperative LSM was associated with postoperative morbidity. The cutoff LSMs <4.5 and >8 kPa predicted the risk of clinically significant post-hepatectomy liver failure (0%, 11%, and 33% in LSM <4.5, 4.5-8, and >8 kPa, respectively) and major complications (0%, 25%, 44% in LSM <4.5, 4.5-8, and >8 kPa, respectively). PSVD is very common among patients undergoing liver surgery for metastases, and it is associated with increased morbidity. LSM and spleen stiffness measurements can correctly identify patients with PSVD and those at risk of clinically relevant postoperative complications.

Burden of illness of non-hematopoietic stem cell transplant-related hepatic sinusoidal obstruction syndrome: A systematic review

Background

Sinusoidal obstruction syndrome (SOS)/veno-occlusive disease (VOD) is generally associated with hematopoietic cell transplant (HCT), but little is known about this condition outside the HCT setting. This systematic review examines the burden of illness and current management approaches in non-HCT SOS/VOD.

Methods

We searched Embase, Medline, and grey literature sources for non-HCT SOS/VOD studies published 2002-2023. Inclusion criteria were studies of any design reporting incidence, diagnosis, underlying disease and any ongoing treatment at the time of SOS/VOD onset, management of non-HCT SOS/VOD, clinical burden, health-related quality of life, healthcare resource use, costs, and patients' unmet needs. Studies investigating pulmonary VOD or SOS/VOD related to the ingestion of pyrrolizidine alkaloids were excluded.Two authors independently screened results, extracted data, and assessed the methodological quality of studies using the Motheral scale for retrospective studies, Newcastle-Ottawa scale for prospective studies and case control studies, the Cochrane risk of bias tool for randomized controlled trials, and the Joanna Briggs Institute critical appraisal tool for case series. Results were synthesized narratively.

Results

Ninety-two studies were included; 57 % were retrospective cohort studies and 70 % were conducted in the US or Europe. The study populations included hematological and solid tumor cancers, various indications for liver transplant, Wilms' tumor, and transfusion-dependent beta thalassemia. Non-HCT SOS/VOD occurs most frequently in people with colorectal liver metastases (CRLM), acute lymphoblastic leukemia (ALL), and acute myeloid leukemia (AML). Approximately 35 % of oxaliplatin-treated CRLM patients and 5 % of ALL and AML patients have non-HCT SOS/VOD. Diagnosis varies according to initial disease setting. Defibrotide is the most frequently reported treatment. Most studies did not clearly report their data sources or methods of outcome assessment.

Conclusion

Non-HCT SOS/VOD occurs in diverse disease conditions, therefore guidelines on diagnosis and treatment are needed to optimize management in clinical practice.

Have we improved postoperative and long-term outcomes of liver surgery for colorectal cancer metastasis? Analysis of 1736 hepatectomies performed over 3 decades in a single center

INTRODUCTION

Surgery is the only potentially curative treatment for colorectal cancer liver metastases (CRLM) and its indication and results have varied in the last 30 years.

METHODS

All patients operated on for CRLM in our centre from 1990 to 2021 were prospectively collected, establishing 3 subgroups based on the year of the first surgery: group A 1990-1999, group B 2000-2010, group C 2011-2021. Clinical characteristics and the results of survival, recurrence and prognostic factors were compared.

RESULTS

1736 hepatectomies were included (Group A n = 208; Group B n = 770; Group C n = 758). Patients in group C had better survival at 5 and 10 years (A 40.5%/28.2%; B 45.9%/32.2%; C 51.6%/33.1%, p = 0.013), although there were no differences between groups in overall recurrence at 5 and 10 years (A 73%/75.7%; B 67.6%/69.2%, and C 63.9%/66%, p = 0.524), nor in liver recurrence (A 46.4%/48.2%; B 45.8%/48.2%; and C 44.4%/48.4%, p = 0.899). An improvement was observed in median survival after recurrence, being 19 months, 23 months, and 31 months (groups A, B and C respectively). Prognostic factors of long-term survival changed over the 3 study periods. The only ones that remained relevant in the last decade were the presence of >4 liver metastasis, extrahepatic disease at the time of hepatectomy, and intraoperative blood transfusion.

CONCLUSIONS

Survival after surgery for CRLM has improved significantly, although this cannot be explained by a reduction in overall and hepatic recurrence, but rather by an improvement in post-recurrence survival. Involvement of the resection margin has lost prognostic value in the last decade.