Changes of liver hemodynamic and elastography parameters in patients with colorectal liver metastases receiving preoperative chemotherapy: “a note of caution”
Abstract Background New systemic chemotherapy agents have improved prognosis in patients with colorectal liver metastases (CLM), but some of them damage the liver parenchyma and ultimately increase postoperative morbidity and mortality after liver resection. The aims of our study were to determine t...
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| Format: | Article |
| Language: | English |
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BMC
2017-12-01
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| Series: | World Journal of Surgical Oncology |
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| Online Access: | http://link.springer.com/article/10.1186/s12957-017-1290-5 |
| _version_ | 1828772087845617664 |
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| author | Amalia Pelegrina Josep Martí Rosa Miquel Joana Ferrer Virginia Hernández-Gea Alba Diaz Cristina Nadal Juan Carlos García-Valdecasas Josep Fuster |
| author_facet | Amalia Pelegrina Josep Martí Rosa Miquel Joana Ferrer Virginia Hernández-Gea Alba Diaz Cristina Nadal Juan Carlos García-Valdecasas Josep Fuster |
| author_sort | Amalia Pelegrina |
| collection | DOAJ |
| description | Abstract Background New systemic chemotherapy agents have improved prognosis in patients with colorectal liver metastases (CLM), but some of them damage the liver parenchyma and ultimately increase postoperative morbidity and mortality after liver resection. The aims of our study were to determine the degree of hemodynamic and pathological liver injury in CLM patients receiving preoperative chemotherapy and to identify an association between these injuries and postoperative complications after liver resection. Methods This is a prospective descriptive study of patients with CLM receiving preoperative chemotherapy before curative liver resection from November 2013 to June 2014. All patients had preoperative elastography and hepatic hemodynamic evaluation. We analyzed clinical preoperative data and postoperative outcomes after grouping the patients by chemotherapy type, development of sinusoidal obstructive syndrome (SOS), and development of major complications. Results Eleven from the 20 patients included in the study received preoperative oxaliplatin-based chemotherapy (OBC). Nine patients had SOS at pathological analysis and five patients developed major complications. Patients receiving preoperative OBC had higher values of hepatic venous pressure gradient (HVPG) and developed more SOS and major complications. Patients developing SOS had higher values of HVPG and developed more major complications. Patients with major complications had higher values of HVPG, and patients with a HVPG of 5 mmHg or greater had more major complications than those under 5 mmHg (20 vs 80%, p = 0.005). Conclusions OBC and SOS impair liver hemodynamics in CLM patients. An increase in major complications after liver resection in these patients develops at subclinical HVPG levels. |
| first_indexed | 2024-12-11T14:37:22Z |
| format | Article |
| id | doaj.art-cc1b23a06932439e8d8044ba04f38096 |
| institution | Directory Open Access Journal |
| issn | 1477-7819 |
| language | English |
| last_indexed | 2024-12-11T14:37:22Z |
| publishDate | 2017-12-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Surgical Oncology |
| spelling | doaj.art-cc1b23a06932439e8d8044ba04f380962022-12-22T01:02:06ZengBMCWorld Journal of Surgical Oncology1477-78192017-12-011511810.1186/s12957-017-1290-5Changes of liver hemodynamic and elastography parameters in patients with colorectal liver metastases receiving preoperative chemotherapy: “a note of caution”Amalia Pelegrina0Josep Martí1Rosa Miquel2Joana Ferrer3Virginia Hernández-Gea4Alba Diaz5Cristina Nadal6Juan Carlos García-Valdecasas7Josep Fuster8Liver Surgery and Transplant Unit, Department of Surgery, Institut de Malalties Digestives i Metabòliques Hospital Clinic Barcelona, IDIBAPS, University of BarcelonaLiver Surgery and Transplant Unit, Department of Surgery, Institut de Malalties Digestives i Metabòliques Hospital Clinic Barcelona, IDIBAPS, University of BarcelonaNetwork for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd)Liver Surgery and Transplant Unit, Department of Surgery, Institut de Malalties Digestives i Metabòliques Hospital Clinic Barcelona, IDIBAPS, University of BarcelonaBarcelona Hemodynamics Laboratory, Liver Unit, IDIBAPS, CIBERehd, Hospital Clínic, University of BarcelonaNetwork for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd)Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd)Liver Surgery and Transplant Unit, Department of Surgery, Institut de Malalties Digestives i Metabòliques Hospital Clinic Barcelona, IDIBAPS, University of BarcelonaLiver Surgery and Transplant Unit, Department of Surgery, Institut de Malalties Digestives i Metabòliques Hospital Clinic Barcelona, IDIBAPS, University of BarcelonaAbstract Background New systemic chemotherapy agents have improved prognosis in patients with colorectal liver metastases (CLM), but some of them damage the liver parenchyma and ultimately increase postoperative morbidity and mortality after liver resection. The aims of our study were to determine the degree of hemodynamic and pathological liver injury in CLM patients receiving preoperative chemotherapy and to identify an association between these injuries and postoperative complications after liver resection. Methods This is a prospective descriptive study of patients with CLM receiving preoperative chemotherapy before curative liver resection from November 2013 to June 2014. All patients had preoperative elastography and hepatic hemodynamic evaluation. We analyzed clinical preoperative data and postoperative outcomes after grouping the patients by chemotherapy type, development of sinusoidal obstructive syndrome (SOS), and development of major complications. Results Eleven from the 20 patients included in the study received preoperative oxaliplatin-based chemotherapy (OBC). Nine patients had SOS at pathological analysis and five patients developed major complications. Patients receiving preoperative OBC had higher values of hepatic venous pressure gradient (HVPG) and developed more SOS and major complications. Patients developing SOS had higher values of HVPG and developed more major complications. Patients with major complications had higher values of HVPG, and patients with a HVPG of 5 mmHg or greater had more major complications than those under 5 mmHg (20 vs 80%, p = 0.005). Conclusions OBC and SOS impair liver hemodynamics in CLM patients. An increase in major complications after liver resection in these patients develops at subclinical HVPG levels.http://link.springer.com/article/10.1186/s12957-017-1290-5Colorectal cancerLiver metastasesHepatic hemodynamicHepatic veins pressure gradientOxaliplatinSinusoidal obstruction syndrome |
| spellingShingle | Amalia Pelegrina Josep Martí Rosa Miquel Joana Ferrer Virginia Hernández-Gea Alba Diaz Cristina Nadal Juan Carlos García-Valdecasas Josep Fuster Changes of liver hemodynamic and elastography parameters in patients with colorectal liver metastases receiving preoperative chemotherapy: “a note of caution” World Journal of Surgical Oncology Colorectal cancer Liver metastases Hepatic hemodynamic Hepatic veins pressure gradient Oxaliplatin Sinusoidal obstruction syndrome |
| title | Changes of liver hemodynamic and elastography parameters in patients with colorectal liver metastases receiving preoperative chemotherapy: “a note of caution” |
| title_full | Changes of liver hemodynamic and elastography parameters in patients with colorectal liver metastases receiving preoperative chemotherapy: “a note of caution” |
| title_fullStr | Changes of liver hemodynamic and elastography parameters in patients with colorectal liver metastases receiving preoperative chemotherapy: “a note of caution” |
| title_full_unstemmed | Changes of liver hemodynamic and elastography parameters in patients with colorectal liver metastases receiving preoperative chemotherapy: “a note of caution” |
| title_short | Changes of liver hemodynamic and elastography parameters in patients with colorectal liver metastases receiving preoperative chemotherapy: “a note of caution” |
| title_sort | changes of liver hemodynamic and elastography parameters in patients with colorectal liver metastases receiving preoperative chemotherapy a note of caution |
| topic | Colorectal cancer Liver metastases Hepatic hemodynamic Hepatic veins pressure gradient Oxaliplatin Sinusoidal obstruction syndrome |
| url | http://link.springer.com/article/10.1186/s12957-017-1290-5 |
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