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Volumetric Analysis of Remnant Liver Regeneration After Major Hepatectomy in Bevacizumab-Treated Patients: A Case-Matched Study in 82 Patients

Millet, Guillaume MD*; Truant, Stéphanie MD, PhD*; Leteurtre, Emmanuelle MD, PhD; Hebbar, Mohamed MD, PhD; Zerbib, Philippe MD, PhD*; Huet, Guillemette PhD§; Boleslawski, Emmanuel MD, PhD*; Pruvot, François-René MD*

doi: 10.1097/SLA.0b013e31827381ca
Original Articles From the ESA Proceedings

Background: The objective was to determine the liver regeneration capacity and morbidity and mortality rates after major hepatectomy for colorectal metastases in patients having undergone bevacizumab-based chemotherapy (bev+).

Patients and Methods: Between 2006 and 2011, 41 patients underwent major hepatectomy within 3 months of bevacizumab and were matched with 41 patients operated on following systemic chemotherapy without bevacizumab (bev−). The matching criteria were the following: number of courses of chemotherapy, chemotherapy-free interval, age, and type of hepatectomy. After measurements of remnant liver volume (RLV) preoperatively and at 1 month (RLV1M), volumetric gain was calculated as absolute (RLV1M-RLV) or relative regeneration [(RLV1M-RLV/RLV)]. Ninety-day morbidity was rated according to the Clavien-Dindo classification.

Results: There were 21 right, 9 extended right, and 11 left hepatectomies in each group. Groups were comparable in terms of matching criteria, body mass index, American Society of Anesthesiologists score, and RLV. No mortalities were observed. There were no intergroup differences in overall morbidity (56% in bev+ vs 34.1%; P = 0.075) or postoperative liver failure. A severe complication occurred in 5 bev+ (4 eviscerations) and 4 bev− (bile leakages) (P = 0.95). The median hospital stay was similar in both groups as were the degrees of absolute and relative liver regeneration (143% in bev+ vs 114%; P = 0.20). Liver regeneration was not influenced by the type of hepatectomy, the number of courses of chemotherapy, or age more than 65 years.

Conclusions: In a methodologically robust trial in the largest cohort reported up to date, bevacizumab did not impair liver regeneration after major hepatectomy—even in elderly patients or those with high exposure to chemotherapy.

We analyzed the effect of preoperative bevacizumab treatment on liver regeneration after major hepatectomy for colorectal metastases. Eighty-two patients were matched for age, resection type, number of courses of chemotherapy, and the time interval before surgery. The liver regeneration rates and postoperative outcomes were not impaired by bevacizumab.

*Department of Digestive Surgery and Transplantation

Department of Pathology

Department of Medical Oncology, Lille University Medical Center, University Nord de France

§INSERM U837, Lille 2 University, Jean-Pierre Aubert Centre, University of Lille-Nord de France, Lille, France.

Reprints: Stéphanie Truant, MD, PhD, Department of Digestive Surgery and Transplantation, Lille University Medical Center, University Nord de France, F-59000 Lille, France. E-mail: s-truant@chru-lille.fr

Stéphanie Truant and Guillaume Millet are co-first authors.

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.