Article Text


Hepatobiliary I
PTU-073 Hepatic sinusoidal injury is associated with shortened long-term survival in patients undergoing right trisectionectomy for colorectal liver metastases
  1. C P Neal,
  2. C D Mann,
  3. G Garcea,
  4. E Pointen,
  5. A McGregor,
  6. M S Metcalfe,
  7. D P Berry,
  8. A R Dennison
  1. Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK


Introduction Recent data have suggested that oxaliplatin-associated sinusoidal injury (SI) in the non-tumour bearing liver (NTBL) may be associated with adverse long-term outcome following hepatectomy for colorectal liver metastases (CRLM), though this observation may be an epiphenomenon of associations with unfavourable tumour biology. This study aimed to assess the impact of NTBL histology upon long-term outcome in a series of consecutive patients undergoing right hepatic trisectionectomy for CRLM.

Methods Clinicopathological data for patients undergoing right trisectionectomy at a UK tertiary referral hepatobiliary centre between January 2002 and December 2008 were obtained from a prospectively maintained database. Blinded NTBL pathological review was conducted by two pathologists using established criteria for SI, steatosis, non-alcoholic steatohepatitis, fibrosis and cholestasis. Univariate and multivariable Cox regression analyses were performed to correlate perioperative and pathological variables with long-term overall and disease-free survival. Postoperative deaths (90-day) were excluded from long-term survival analyses.

Results A total of 66 consecutive patients underwent right trisectionectomy for CRLM over the study period. Preoperative oxaliplatin-based chemotherapy was used in 24 cases (36.4%, median 6 cycles, range 2–8 cycles). SI was noted in 21 cases (31.8%) and was independently associated with oxaliplatin use. 5-Year overall survival rate was 28.8%. On multivariable analysis, number of metastases resected and SI were independently associated with shortened overall survival following trisectionectomy. Number of metastases resected, perioperative blood transfusion and SI were independently associated with shortened disease-free survival following trisectionectomy. Steatosis, non-alcoholic steatohepatitis, fibrosis and cholestasis showed no association with long-term survival.

Conclusion Short-course oxaliplatin-associated SI is associated with adverse prognosis following right trisectionectomy for CRLM. The inclusion of traditional clinicopathological variables as covariates suggests that this finding is unlikely to simply be an epiphenomenon of associations with unfavourable tumour biology. Further studies are necessary to confirm these findings and to explore the underlying mechanism(s).

Competing interests None declared.

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