Splenic enlargement induced by preoperative chemotherapy is a useful indicator for predicting liver regeneration after resection for colorectal liver metastases
Abstract Background Conversion chemotherapy may downsize unresectable colorectal liver metastases (CRLMs), but may cause liver injury and splenic enlargement. The effect of preoperative chemotherapy on liver regeneration after liver resection remains undetermined. The aim of this study was to examin...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | World Journal of Surgical Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12957-020-01918-4 |
| _version_ | 1819080259550576640 |
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| author | Takanori Konishi Hiroyuki Yoshidome Hiroaki Shimizu Hideyuki Yoshitomi Katsunori Furukawa Tsukasa Takayashiki Satoshi Kuboki Shigetsugu Takano Masaru Miyazaki Masayuki Ohtsuka |
| author_facet | Takanori Konishi Hiroyuki Yoshidome Hiroaki Shimizu Hideyuki Yoshitomi Katsunori Furukawa Tsukasa Takayashiki Satoshi Kuboki Shigetsugu Takano Masaru Miyazaki Masayuki Ohtsuka |
| author_sort | Takanori Konishi |
| collection | DOAJ |
| description | Abstract Background Conversion chemotherapy may downsize unresectable colorectal liver metastases (CRLMs), but may cause liver injury and splenic enlargement. The effect of preoperative chemotherapy on liver regeneration after liver resection remains undetermined. The aim of this study was to examine whether splenic enlargement induced by preoperative chemotherapy is an indicator to identify high-risk patients for impaired liver regeneration and liver dysfunction after resection. Methods We retrospectively reviewed 118 Japanese patients with CRLMs. Fifty-one patients had conversion chemotherapy. The other 67 patients underwent up-front liver resection. We clarified effects of conversion chemotherapy on splenic volume, liver function, and postoperative liver regeneration. Perioperative outcome was also analyzed. Results A ratio of the splenic volume before and after chemotherapy (SP index) in the oxaliplatin-based chemotherapy group was significantly greater than other chemotherapy groups after 9 or more chemotherapy cycles. Patients whose SP index was 1.2 or more had significantly higher indocyanine green retention rate at 15 min (ICG-R15) than patients without chemotherapy. Analyses of covariance showed liver regeneration rate after resection was decreased in patients whose SP index was 1.2 or more. The incidence of postoperative liver dysfunction in patients whose SP index was 1.2 or more was significantly greater than patients without chemotherapy. Multivariate analysis showed SP index was a significant predictive factor of impaired liver regeneration. Conclusions Splenic enlargement induced by preoperative chemotherapy was a useful indicator for impaired liver regeneration after resection and a decision-making tool of treatment strategy for unresectable CRLMs. |
| first_indexed | 2024-12-21T19:42:02Z |
| format | Article |
| id | doaj.art-889936035a7440a2b96ebc58a3d77868 |
| institution | Directory Open Access Journal |
| issn | 1477-7819 |
| language | English |
| last_indexed | 2024-12-21T19:42:02Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Surgical Oncology |
| spelling | doaj.art-889936035a7440a2b96ebc58a3d778682022-12-21T18:52:26ZengBMCWorld Journal of Surgical Oncology1477-78192020-06-011811910.1186/s12957-020-01918-4Splenic enlargement induced by preoperative chemotherapy is a useful indicator for predicting liver regeneration after resection for colorectal liver metastasesTakanori Konishi0Hiroyuki Yoshidome1Hiroaki Shimizu2Hideyuki Yoshitomi3Katsunori Furukawa4Tsukasa Takayashiki5Satoshi Kuboki6Shigetsugu Takano7Masaru Miyazaki8Masayuki Ohtsuka9Department of General Surgery, Chiba University Graduate School of MedicineDepartment of General Surgery, Chiba University Graduate School of MedicineDepartment of General Surgery, Chiba University Graduate School of MedicineDepartment of General Surgery, Chiba University Graduate School of MedicineDepartment of General Surgery, Chiba University Graduate School of MedicineDepartment of General Surgery, Chiba University Graduate School of MedicineDepartment of General Surgery, Chiba University Graduate School of MedicineDepartment of General Surgery, Chiba University Graduate School of MedicineDepartment of General Surgery, Chiba University Graduate School of MedicineDepartment of General Surgery, Chiba University Graduate School of MedicineAbstract Background Conversion chemotherapy may downsize unresectable colorectal liver metastases (CRLMs), but may cause liver injury and splenic enlargement. The effect of preoperative chemotherapy on liver regeneration after liver resection remains undetermined. The aim of this study was to examine whether splenic enlargement induced by preoperative chemotherapy is an indicator to identify high-risk patients for impaired liver regeneration and liver dysfunction after resection. Methods We retrospectively reviewed 118 Japanese patients with CRLMs. Fifty-one patients had conversion chemotherapy. The other 67 patients underwent up-front liver resection. We clarified effects of conversion chemotherapy on splenic volume, liver function, and postoperative liver regeneration. Perioperative outcome was also analyzed. Results A ratio of the splenic volume before and after chemotherapy (SP index) in the oxaliplatin-based chemotherapy group was significantly greater than other chemotherapy groups after 9 or more chemotherapy cycles. Patients whose SP index was 1.2 or more had significantly higher indocyanine green retention rate at 15 min (ICG-R15) than patients without chemotherapy. Analyses of covariance showed liver regeneration rate after resection was decreased in patients whose SP index was 1.2 or more. The incidence of postoperative liver dysfunction in patients whose SP index was 1.2 or more was significantly greater than patients without chemotherapy. Multivariate analysis showed SP index was a significant predictive factor of impaired liver regeneration. Conclusions Splenic enlargement induced by preoperative chemotherapy was a useful indicator for impaired liver regeneration after resection and a decision-making tool of treatment strategy for unresectable CRLMs.http://link.springer.com/article/10.1186/s12957-020-01918-4HepatectomySplenomegalyConversion chemotherapyColorectal liver metastasesLiver regeneration |
| spellingShingle | Takanori Konishi Hiroyuki Yoshidome Hiroaki Shimizu Hideyuki Yoshitomi Katsunori Furukawa Tsukasa Takayashiki Satoshi Kuboki Shigetsugu Takano Masaru Miyazaki Masayuki Ohtsuka Splenic enlargement induced by preoperative chemotherapy is a useful indicator for predicting liver regeneration after resection for colorectal liver metastases World Journal of Surgical Oncology Hepatectomy Splenomegaly Conversion chemotherapy Colorectal liver metastases Liver regeneration |
| title | Splenic enlargement induced by preoperative chemotherapy is a useful indicator for predicting liver regeneration after resection for colorectal liver metastases |
| title_full | Splenic enlargement induced by preoperative chemotherapy is a useful indicator for predicting liver regeneration after resection for colorectal liver metastases |
| title_fullStr | Splenic enlargement induced by preoperative chemotherapy is a useful indicator for predicting liver regeneration after resection for colorectal liver metastases |
| title_full_unstemmed | Splenic enlargement induced by preoperative chemotherapy is a useful indicator for predicting liver regeneration after resection for colorectal liver metastases |
| title_short | Splenic enlargement induced by preoperative chemotherapy is a useful indicator for predicting liver regeneration after resection for colorectal liver metastases |
| title_sort | splenic enlargement induced by preoperative chemotherapy is a useful indicator for predicting liver regeneration after resection for colorectal liver metastases |
| topic | Hepatectomy Splenomegaly Conversion chemotherapy Colorectal liver metastases Liver regeneration |
| url | http://link.springer.com/article/10.1186/s12957-020-01918-4 |
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