Extended preoperative chemotherapy, extent of liver resection and blood transfusion are predictive factors of liver failure following resection of colorectal liver metastasis H.S.C. Ribeiro a, * , W.L. Costa Jr. a , A.L. Diniz a , A.L. Godoy a , P. Herman b , R.A. Coudry c , M.D.F.S. Begnami d , C.A.L. Mello e , M.J.B. Silva e , C.E. Zurstrassen f , F.J.F. Coimbra a,g, * a Department of Abdominal Surgery, A.C. Camargo Cancer Hospital, Rua Antonio Prudente, 211 Liberdade, CEP 01501-900, Sao Paulo, Brazil b Department of Gastroenterology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil c Department of Surgical Pathology, ICESP, Sao Paulo, Brazil d Department of Surgical Pathology, A.C. Camargo Cancer Hospital, Sao Paulo, Brazil e Department of Clinical Oncology, A.C. Camargo Cancer Hospital, Sao Paulo, Brazil f Department of Interventional Radiology, A.C. Camargo Cancer Hospital, Sao Paulo, Brazil g Department of Abdominal Surgery, A.C.Camargo Cancer Hospital, Sao Paulo, Brazil Accepted 7 December 2012 Available online --- Abstract Aim: The aim of this study was to determine the incidence and prognostic factors of postoperative liver failure in patients submitted to liver resection for colorectal metastases. Method: Patients with CLM who underwent hepatectomy from 1998 to 2009 were included in retrospective analysis. Postoperative liver failure was defined using either the 50e50 criteria or the peak of serum bilirubin level above 7 mg/dL independently. Results: Two hundred and nine (209) procedures were performed in 170 patients. 120 surgeries were preceded by chemotherapy within six months. The overall morbidity rate was 53.1% and 90-day mortality was 2.3%. Postoperative liver failure occurred in 10% of all proce- dures, accounting for a mortality rate of 9.5% among this group of patients. In multivariate analysis, extent of liver resection, need of blood transfusion and more than eight preoperative chemotherapy cycles were independent prognostic factors of postoperative liver insufficiency. This complication was not related with the chemotherapy regimen used. Conclusion: We conclude that postoperative liver failure has a relatively low incidence (10%) after CLM resection, but a remarkable impact on postoperative mortality rate. The amount of liver resected, the need of blood transfusion and extended preoperative chemotherapy are independent predictors of its occurrence and this knowledge can be used to prevent postoperative liver failure in a multidisciplinary ap- proach. Ó 2013 Elsevier Ltd. All rights reserved. Keywords: Colorectal liver metastases; Liver resection; Liver failure; Chemotherapy Introduction Colorectal cancer is known to be the third most common type of cancer worldwide. 1 Approximately half of the patients diagnosed with this malignancy develop liver metastases, which account for two-thirds of colorectal cancer-related deaths. 2 Surgical resection is the gold standard treatment in patients with colorectal liver metastases. 3,4 Combined strategies associating chemotherapy and surgery are increas- ingly been employed, due to the high incidence of relapse fol- lowing hepactectomy. Furthermore, systemic treatment can reduce tumour burden and allows surgical resection in case of extensive liver metastatic disease. 5 Death following hepatic resection mostly results from postoperative liver failure, which is frequently caused by hepatopathies or associated morbidities (diabetes mellitus, obesity, and advanced age among others) and also depends on the surgical technique employed, the liver remnant vol- ume and the occurrence of intra-operative bleeding. 6 The precise incidence of this complication has not been defined * Corresponding authors. Tel.: þ55 11 21895000. E-mail addresses: hsalvadorcr@gmail.com (H.S.C. Ribeiro), coimbra.felipe@uol.com.br (F.J.F. Coimbra). 0748-7983/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ejso.2012.12.020 Available online at www.sciencedirect.com EJSO xx (2013) 1e6 www.ejso.com Please cite this article in press as: Ribeiro HSC, et al., Extended preoperative chemotherapy, extent of liver resection and blood transfusion are predictive factors of liver failure following resection of colorectal liver metastasis, Eur J Surg Oncol (2013), http://dx.doi.org/10.1016/j.ejso.2012.12.020