Preoperative Liver Hypertrophy Induced by Portal Flow Occlusion Before Major Hepatic Resection for Colorectal Metastases Can Be Impaired by Bevacizumab
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This prospective study evaluated the effect of bevacizumab on the hypertrophy of the future liver remnant (FLR) after portal vein occlusion (PVO) before major hepatectomy for colorectal liver metastases.
Twenty-seven patients with colorectal liver metastases treated with preoperative FOLFOX/FOLFIRI chemotherapy regimen since 2002 were evaluated for the degree of hypertrophy of the FLR after right PVO. The results were compared with a similar group of 13 patients treated since 2006 with a chemotherapeutic regimen including bevacizumab and PVO. The FLR was measured by volumetric computed tomography 4 weeks before and after PVO.
Before PVO, the FLR volumes were similar in the 13 patients who received bevacizumab (bev+) (mean ± standard deviation, 497 ± 136 cm3) and the 27 patients who did not receive bevacizumab (bev−) (511 ± 222 cm3, P = NS). After PVO, the increase in the FLR volume was significantly lower in the bev+ group (561 ± 171 cm3) compared with the bev− group (667 ± 213 cm3, P < .031). In the bev+ group, patients who had received six or more cycles and were ≥60 years old experienced far lower hypertrophy. A right hepatectomy was performed in 29 patients (72%) without mortality and no clinically important differences in morbidity.
Bevacizumab may impair hypertrophy of the FLR after PVO in preparation for major hepatectomy particularly, in patients aged ≥60 years and those who receive six or more cycles of bevacizumab, suggesting that major liver resection should be considered with caution in patients who have received bevacizumab.
KeywordsBevacizumab Liver Regeneration Colorectal Liver Metastasis Portal Vein Embolization Major Hepatectomy
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