AIM: To assess the effects of preoperative treatment on the hepatic histology of non-tumoral liver and the postoperative outcome. METHODS: One hundred and six patients underwent hepatic resection for colorectal metast...AIM: To assess the effects of preoperative treatment on the hepatic histology of non-tumoral liver and the postoperative outcome. METHODS: One hundred and six patients underwent hepatic resection for colorectal metastases between 1999 and 2009. The surgical specimens were reviewed with established criteria for diagnosis and grading of pathological hepatic injury. The impact of preoperative therapy on liver injury and postoperative outcome was analyzed.alone, whereas 42 patients (39.6%) received neoadjuvant chemotherapy and 11 (10.4%) patients received preoperative hepatic artery infusion (HAI). Chemotherapy included oxaliplatin-based regimens (31.1%) and irinotecan-based regimens (8.5%). On histopathological analysis, 16 patients (15.1%) had steatosis, 31 (29.2%) had sinusoidal dilation and 20 patients (18.9%) had steatohepatitis. Preoperative oxaliplatin was associated with sinusoidal dilation compared with surgery alone (42.4% vs 20.8%, P = 0.03); however, the perioperative complication rate was not significantly different between the oxaliplatin group and surgery group (27.3% vs 13.2%, P = 0.1). HAI was associated with more steatosis, sinusoidal dilation and steatohepatitis than the surgery group, with higher perioperative morbidity (36.4% vs 13.2%, P = 0.06) and mortality (9.1% vs 0% P = 0.02). CONCLUSION: Preoperative oxaliplatin was associated with sinusoidal dilation compared with surgery alone. However, the preoperative oxaliplatin had no significant impact on perioperative outcomes. HAI can cause pathological changes and tends to increase perioperative morbidity and mortality.展开更多
Colorectal carcinoma(CRC)is one of the leading causes of cancer-related deaths worldwide,and up to 50%of patients with CRC develop colorectal liver metastases(CRLM).For these patients,surgical resection remains the on...Colorectal carcinoma(CRC)is one of the leading causes of cancer-related deaths worldwide,and up to 50%of patients with CRC develop colorectal liver metastases(CRLM).For these patients,surgical resection remains the only opportunity for cure and long-term survival.Over the past few decades,outcomes of patients with metastatic CRC have improved significantly due to advances in systemic therapy,as well as improvements in operative technique and perioperative care.Chemotherapy in the modern era of oxaliplatin-and irinotecancontaining regimens has been augmented by the introduction of targeted biologics and immunotherapeutic agents.The increasing efficacy of contemporary systemic therapies has led to an expansion in the proportion of patients eligible for curative-intent surgery.Consequently,the use of neoadjuvant strategies is becoming progressively more established.For patients with CRLM,the primary advantage of neoadjuvant chemotherapy(NCT)is the potential to down-stage metastatic disease in order to facilitate hepatic resection.On the other hand,the routine use of NCT for patients with resectable metastases remains controversial,especially given the potential risk of inducing chemotherapy-associated liver injury prior to hepatectomy.Current guidelines recommend upfront surgery in patients with initially resectable disease and low operative risk,reserving NCT for patients with borderline resectable or unresectable disease and high operative risk.Patients undergoing NCT require close monitoring for tumor response and conversion of CRLM to resectability.In light of the growing number of treatment options available to patients with metastatic CRC,it is generally agreed that these patients are best served at tertiary centers with an expert multidisciplinary team.展开更多
Objective Chemotherapy may cause drug-induced liver damage and studying the effectiveness of hepatoprotective substances in the clinical context is still warranted. We assessed the effectiveness of three commonly use...Objective Chemotherapy may cause drug-induced liver damage and studying the effectiveness of hepatoprotective substances in the clinical context is still warranted. We assessed the effectiveness of three commonly used natural substances for liver protection in East Asia. Methods： Retrospectively, we collected all medical records during a period of three years of cancer patients that underwent chemotherapy treatment and received glutathione, magnesium isoglicyrrhyzinate or polyene phosphatidylcholine at a Chinese integrative medicine hospital. Liver enzymes before and after one treatment cycle were detected. Paired t-test, chi-square, Snedcor＇s F distribution and ANOVA were used to analyze data. Results： 98 individuals were eligible for inclusion. After treatment, in the glutathione group, there were lower values in alanine aminotransferase （P 〈 0.05） and aspartate aminotransferase （P 〈 0.05）. There was also a lower level of liver injury in patients （P 〈 0.05）. In the magnesium isoglycyrrhizinate group there were lower values in total protein （P 〈 0.05）, alkaline phosphatase （P 〈 0.05） and gamma glutamyl transpeptidase values （P 〈 0.05）. There was also a lower level of liver injury in patients after treatment （P 〈 0.05）. In the polyene phosphatidylcholine group, there were no lower values of interest, including those of liver injury in patients （P 〉 0.05）. Conclusion： Glutathione and magnesium isoglicyrrhyzinate may be similarly effective in preserving liver function and preventing drug-induced liver injury in cancer patients undergoing chemotherapy. Polyene phosphatidylcholine may have no significant activity in protecting liver function and preventing drug-induced liver injury in advanced cancer patients undergoing chemotherapy. Since elevated glutathione levels may increase the antioxidant capacity and the resistance to oxidative stress by cancer cells, it is plausible to conclude that maintenance of high intracellular levels of glutathione could be critical for metastatic cells growth.展开更多
基金Supported by National Science and Technology Major Project Grant, No. 2011ZX09302-001-02
文摘AIM: To assess the effects of preoperative treatment on the hepatic histology of non-tumoral liver and the postoperative outcome. METHODS: One hundred and six patients underwent hepatic resection for colorectal metastases between 1999 and 2009. The surgical specimens were reviewed with established criteria for diagnosis and grading of pathological hepatic injury. The impact of preoperative therapy on liver injury and postoperative outcome was analyzed.alone, whereas 42 patients (39.6%) received neoadjuvant chemotherapy and 11 (10.4%) patients received preoperative hepatic artery infusion (HAI). Chemotherapy included oxaliplatin-based regimens (31.1%) and irinotecan-based regimens (8.5%). On histopathological analysis, 16 patients (15.1%) had steatosis, 31 (29.2%) had sinusoidal dilation and 20 patients (18.9%) had steatohepatitis. Preoperative oxaliplatin was associated with sinusoidal dilation compared with surgery alone (42.4% vs 20.8%, P = 0.03); however, the perioperative complication rate was not significantly different between the oxaliplatin group and surgery group (27.3% vs 13.2%, P = 0.1). HAI was associated with more steatosis, sinusoidal dilation and steatohepatitis than the surgery group, with higher perioperative morbidity (36.4% vs 13.2%, P = 0.06) and mortality (9.1% vs 0% P = 0.02). CONCLUSION: Preoperative oxaliplatin was associated with sinusoidal dilation compared with surgery alone. However, the preoperative oxaliplatin had no significant impact on perioperative outcomes. HAI can cause pathological changes and tends to increase perioperative morbidity and mortality.
文摘Colorectal carcinoma(CRC)is one of the leading causes of cancer-related deaths worldwide,and up to 50%of patients with CRC develop colorectal liver metastases(CRLM).For these patients,surgical resection remains the only opportunity for cure and long-term survival.Over the past few decades,outcomes of patients with metastatic CRC have improved significantly due to advances in systemic therapy,as well as improvements in operative technique and perioperative care.Chemotherapy in the modern era of oxaliplatin-and irinotecancontaining regimens has been augmented by the introduction of targeted biologics and immunotherapeutic agents.The increasing efficacy of contemporary systemic therapies has led to an expansion in the proportion of patients eligible for curative-intent surgery.Consequently,the use of neoadjuvant strategies is becoming progressively more established.For patients with CRLM,the primary advantage of neoadjuvant chemotherapy(NCT)is the potential to down-stage metastatic disease in order to facilitate hepatic resection.On the other hand,the routine use of NCT for patients with resectable metastases remains controversial,especially given the potential risk of inducing chemotherapy-associated liver injury prior to hepatectomy.Current guidelines recommend upfront surgery in patients with initially resectable disease and low operative risk,reserving NCT for patients with borderline resectable or unresectable disease and high operative risk.Patients undergoing NCT require close monitoring for tumor response and conversion of CRLM to resectability.In light of the growing number of treatment options available to patients with metastatic CRC,it is generally agreed that these patients are best served at tertiary centers with an expert multidisciplinary team.
文摘Objective Chemotherapy may cause drug-induced liver damage and studying the effectiveness of hepatoprotective substances in the clinical context is still warranted. We assessed the effectiveness of three commonly used natural substances for liver protection in East Asia. Methods： Retrospectively, we collected all medical records during a period of three years of cancer patients that underwent chemotherapy treatment and received glutathione, magnesium isoglicyrrhyzinate or polyene phosphatidylcholine at a Chinese integrative medicine hospital. Liver enzymes before and after one treatment cycle were detected. Paired t-test, chi-square, Snedcor＇s F distribution and ANOVA were used to analyze data. Results： 98 individuals were eligible for inclusion. After treatment, in the glutathione group, there were lower values in alanine aminotransferase （P 〈 0.05） and aspartate aminotransferase （P 〈 0.05）. There was also a lower level of liver injury in patients （P 〈 0.05）. In the magnesium isoglycyrrhizinate group there were lower values in total protein （P 〈 0.05）, alkaline phosphatase （P 〈 0.05） and gamma glutamyl transpeptidase values （P 〈 0.05）. There was also a lower level of liver injury in patients after treatment （P 〈 0.05）. In the polyene phosphatidylcholine group, there were no lower values of interest, including those of liver injury in patients （P 〉 0.05）. Conclusion： Glutathione and magnesium isoglicyrrhyzinate may be similarly effective in preserving liver function and preventing drug-induced liver injury in cancer patients undergoing chemotherapy. Polyene phosphatidylcholine may have no significant activity in protecting liver function and preventing drug-induced liver injury in advanced cancer patients undergoing chemotherapy. Since elevated glutathione levels may increase the antioxidant capacity and the resistance to oxidative stress by cancer cells, it is plausible to conclude that maintenance of high intracellular levels of glutathione could be critical for metastatic cells growth.
