The effect of hepatic steatosis on survival following resection of colorectal liver metastases in patients without preoperative chemotherapy

Ed Parkin, Derek A. O'Reilly, Rene Adam, Gernot M. Kaiser, Christophe Laurent, Dominique Elias, Lorenzo Capussotti, Andrew G. Renehan

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Background Hepatic steatosis, a common condition associated with insulin resistance and excess body weight, is reported to be associated with an increased risk for perioperative mortality in patients undergoing resection of colorectal liver metastases (CLM), but its impact upon longterm survival is less well documented. Methods The effects of background liver pathology, categorized as 'normal', 'with steatosis' and 'other', on perioperative mortality, overall survival (OS) and cancer-specific survival (CSS) were assessed in patients undergoing resection for CLM according to data maintained in the LiverMetSurvey database. As preoperative chemotherapy may confound the effects of steatosis, patients who had been given preoperative chemotherapy were excluded. Survival analyses included log-rank tests for comparisons, and multivariate Cox models, including well-established prognosticators. Results Of 5853 patients who underwent first-time liver resection without preoperative chemotherapy, 1793 (30.6%) had background steatosis. Rates of 90-day perioperative mortality in patients with normal, steatosis and other pathologies were 2.8%, 2.1% and 4.9%, respectively. Steatosis was associated with improved 5-year OS (47.4% versus 43.0%; log rank, P = 0.0017) and CSS (56.1% versus 50.3%; P = 0.002) compared with normal background liver. After adjustments, the survival advantage associated with steatosis remained (hazard ratio = 0.806, 95% confidence interval 0.717-0.905 for CSS). Discussion The paradoxical survival advantage observed in patients with steatosis undergoing liver resection for CLM generates a hypothesis that peri-diagnosis of excess body adiposity has a survival protective effect that warrants further research. © 2012 International Hepato-Pancreato-Biliary Association.
    Original languageEnglish
    Pages (from-to)463-472
    Number of pages9
    JournalHPB
    Volume15
    Issue number6
    DOIs
    Publication statusPublished - Jun 2013

    Fingerprint

    Dive into the research topics of 'The effect of hepatic steatosis on survival following resection of colorectal liver metastases in patients without preoperative chemotherapy'. Together they form a unique fingerprint.

    Cite this