Reversibility of chemotherapy-related liver injury

Luca Vigano, Giovanni De Rosa, Christian Toso, Christian Toso, Axel Andres, Axel Andres, Alessandro Ferrero, Arnaud Roth, Arnaud Roth, Elisa Sperti, Pietro Majno, Pietro Majno, Laura Rubbia-Brandt, Laura Rubbia-Brandt

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© 2017 European Association for the Study of the Liver Background & Aims Chemotherapy-associated liver injury (CALI) increases the risk of liver resection and may prejudice further surgery and chemotherapy. The reversibility of CALI is therefore important; however, no data concerning this are available. This study aimed to retrospectively analyze the reversibility of CALI in patients undergoing liver resection for colorectal metastases. Methods All resections of colorectal liver metastases after oxaliplatin and/or irinotecan-based chemotherapy were included. First, liver resections were stratified by time between end of chemotherapy and hepatectomy and several possible cut-off values tested. CALI prevalence in various groups was compared. Second, CALI in the two specimens from each patient who had undergone repeat liver resections without interval chemotherapy were compared. Results Overall, 524 liver resections in 429 patients were analyzed. The median interval chemotherapy–surgery was 56 days (15–1264). CALI prevalence did not differ significantly between groups with a chemotherapy–surgery interval <270 days. Grade 2–3 sinusoidal dilatation (SOS, 19.4% vs. 40.0%, p = 0.022) and nodular regenerative hyperplasia (NRH, 6.5% vs. 20.1%, p = 0.063) occurred less frequently in patients with an interval > 270 days (n = 31); prevalence of steatosis and steatohepatitis was similar in all groups. A chemotherapy–surgery interval > 270 days was an independent protector against Grade 2–3 SOS (p = 0.009). Forty-seven patients had repeat liver resection without interval chemotherapy. CALI differed between surgeries only for a chemotherapy–surgery interval > 270 days (n = 15), Grade 2–3 SOS having regressed in 4/5 patients and NRH in 7/8; whereas steatosis and steatohepatitis had persisted. Conclusions CALI persists for a long time after chemotherapy. SOS and NRH regress only after nine months without chemotherapy, whereas steatosis and steatohepatitis persist. Lay summary The patients affected by colorectal liver metastases often receive chemotherapy before liver resection, but chemotherapy causes liver injuries that may increase operative risks and reduce tolerance to further chemotherapy. The authors analyzed the reversibility of the liver injuries after the chemotherapy interruption. Liver injuries persist for a long time after chemotherapy. Sinusoidal dilatation and nodular regenerative hyperplasia regress only nine months after the end of chemotherapy, whereas steatosis and steatohepatitis persist even after this long interval.
Original languageEnglish
Pages (from-to)84-91
Number of pages8
JournalJournal of Hepatology
Issue number1
Publication statusPublished - Jul 1 2017


  • Chemotherapy-associated liver injury
  • Liver failure
  • Liver surgery for colorectal metastases
  • Nodular regenerative hyperplasia
  • Reversibility of liver injury
  • Sinusoidal dilatation
  • Steatohepatitis
  • Steatosis

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    Vigano, L., De Rosa, G., Toso, C., Toso, C., Andres, A., Andres, A., Ferrero, A., Roth, A., Roth, A., Sperti, E., Majno, P., Majno, P., Rubbia-Brandt, L., & Rubbia-Brandt, L. (2017). Reversibility of chemotherapy-related liver injury. Journal of Hepatology, 67(1), 84-91.