Nodular Regenerative Hyperplasia in Patients Undergoing Liver Resection for Colorectal Metastases After Chemotherapy: Risk Factors, Preoperative Assessment and Clinical Impact

• Published in: Annals of surgical oncology Vol. 22; no. 13; pp. 4149 - 4157
• Main Authors: Viganò, Luca, Rubbia-Brandt, Laura, De Rosa, Giovanni, Majno, Pietro, Langella, Serena, Toso, Christian, Mentha, Gilles, Capussotti, Lorenzo
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2015; Springer Nature B.V
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Chemotherapy, Adjuvant; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - secondary; Colorectal Neoplasms - surgery; Combined Modality Therapy; Female; Focal Nodular Hyperplasia - diagnosis; Focal Nodular Hyperplasia - etiology; Follow-Up Studies; Hepatectomy; Hepatobiliary Tumors; Humans; Liver Neoplasms - drug therapy; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver Regeneration; Male; Medicine; Medicine & Public Health; Neoplasm Staging; Oncology; Postoperative Complications; Preoperative Care; Prognosis; Risk Factors; Surgery; Surgical Oncology; Portal Hypertension; Oxaliplatin; Liver Resection; Major Hepatectomy; Bevacizumab
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-015-4533-0

Background Nodular regenerative hyperplasia (NRH) is a severe form of chemotherapy-related liver injury (CALI) that may worsen the short-term outcome of liver resection (LR) for colorectal metastases (CRLM). The present study aimed to clarify the incidence, risk factors, preoperative assessment, and clinical impact of NRH. Methods Overall, 406 patients undergoing 478 LRs for CRLM after chemotherapy between 2000 and 2012 were studied. All resection specimens were reviewed. After Gomori staining, NRH was graded according to the Wanless score. Results NRH was diagnosed in 87 (18.2 %) patients, grades 2–3 in 14 (2.9 %) patients. At multivariate analysis, the prevalence of NRH was increased after oxaliplatin administration (21.4 vs. 8.4 %; p  = 0.003), and reduced by the addition of bevacizumab (11.7 vs. 19.8 %; p  = 0.020). Two parameters predicted the presence of NRH: the APRI score (AST to platelet ratio index: 25.5 % if >0.36 vs. 9.8 % if ≤0.36; p  = 0.004), and the platelet count (63.6 % if <100 × 10 3 /mm 3 vs. 25.3 % if 100–200 × 10 3 /mm 3 vs. 11.9 % if >200 × 10 3 /mm 3 ; p  = 0.032). Ninety-day mortality and liver failure rates were 0.6 and 3.6 %. NRH was an independent predictor of postoperative liver failure (9.2 % if present vs. 2.3 % if not present; p  = 0.021). In patients with grades 2–3 NRH, the rate of liver failure was 14.3 %, 25.0 % after major hepatectomy. No other forms of CALI impacted short-term outcomes. Conclusions NRH was the most relevant form of CALI, increasing the risk of postoperative liver failure. Oxaliplatin increased the incidence of NRH, while bevacizumab decreased it. The APRI score and platelet count were useful tools for predicting NRH.