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Chemotherapy-Associated Liver Injury in Patients with Colorectal Liver Metastases: A Systematic Review and Meta-analysis

Lookup NU author(s): Stuart Robinson, Professor Colin Wilson, Professor Alastair BurtORCiD, Professor Derek Manas, Steven White



Chemotherapy-associated liver injury is a major cause for concern when treating patients with colorectal liver metastases. The aim of this review was to determine the pathological effect of specific chemotherapy regimens on the hepatic parenchyma as well as on surgical morbidity, mortality and overall survival. A systematic review of the published literature and a meta-analysis were performed. For each of the variables under consideration, the effects of different chemotherapy regimens were determined by calculation of relative risks by a random-effects model. Hepatic parenchymal injury is regimen specific, with oxaliplatin-based regimens being associated with grade 2 or greater sinusoidal injury (number needed to harm 8; 95 % confidence interval [CI] 6.4-13.6), whereas irinotecan-based regimens associated with steatohepatitis (number needed to harm 12; 95 % CI 7.8-26). The use of bevacizumab alongside FOLFOX reduces the risk of grade 2 or greater sinusoidal injury (relative risk 0.34; 95 % CI 0.15-0.75). Chemotherapy before resection of colorectal liver metastases is associated with an increased risk of regimen-specific liver injury. This liver injury may have implications for the functional reserve of the liver for patients undergoing major hepatectomy for colorectal liver metastases.

Publication metadata

Author(s): Robinson SM, Wilson CH, Burt AD, Manas DM, White SA

Publication type: Review

Publication status: Published

Journal: Annals of Surgical Oncology

Year: 2012

Volume: 19

Issue: 13

Pages: 4287-4299

Print publication date: 01/12/2012

ISSN (print): 1068-9265

ISSN (electronic): 1534-4681

Publisher: SPRINGER


DOI: 10.1245/s10434-012-2438-8