What is a safe future liver remnant size in patients undergoing major hepatectomy for colorectal liver metastases and treated by intensive preoperative chemotherapy

Annals of Surgical Oncology, 03/30/2012

This study provides a cutoff future liver remnant (FLR) ratio for safe postoperative outcome after major hepatectomy in colorectal liver metastases (CLM) patients receiving six or more cycles of preoperative chemotherapy.

Methods

  • Between January 2000 and August 2010, a total of 101 consecutive patients with CLM underwent major hepatectomy after preoperative chemotherapy (≥6 cycles of oxaliplatin or irinotecan regimen with or without targeted therapies).
  • The FLR ratio was calculated by two formulas: actual FLR (aFLR) ratio, and standardized FLR (sFLR) ratio.
  • Predictors of postoperative overall morbidity, sepsis, and liver failure were identified by univariate and multivariate analyses.

Results

  • Fifty–eight patients (57.4%) had 95 postoperative complications.
  • Sepsis and postoperative liver failure occurred in 23 (22.8%) and 16 patients (15.8%), respectively.
  • On univariate analysis, small aFLR ratio was significantly associated with all complications, and sFLR ratio was associated with sepsis and liver failure.
  • In receiver–operating characteristic analysis, the cutoff of aFLR ratio in predicting overall morbidity, sepsis, and liver failure was 44.8, 43.1, and 37.7%, respectively, and that of sFLR ratio in predicting sepsis and liver failure was 43.6 and 48.5%, respectively.
  • On multivariate analysis, these aFLR and sFLR ratio cutoffs were independent predictors of all complications and of sepsis and liver failure, respectively.

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