Ann Surg Treat Res.  2024 Dec;107(6):346-353. 10.4174/astr.2024.107.6.346.

Perioperative outcomes of sinusoidal obstruction syndrome in patients undergoing liver resection for colorectal metastases after neoadjuvant chemotherapy: a retrospective cohort research

• Woo Y
• Choi HJ
• Lee SH
• Choi Y
• Park SE
• Hong TH
• You YK

• KMID: 2562310
• DOI: http://doi.org/10.4174/astr.2024.107.6.346

Abstract

Purpose
We investigated the factors that affect the occurrence of sinusoidal obstruction syndrome (SOS) and the effect of SOS on the patient’s perioperative outcomes through histological review of liver resection specimens from patients who underwent chemotherapy.
Methods
From December 2007 to December 2020, liver specimens from patients who underwent liver resection for colorectal liver metastasis after neoadjuvant chemotherapy were analyzed regarding liver damage in the nontumorous lesion. Through pathological review, patients with grade 1–3 sinusoidal dilatation were categorized into the SOS (+) group, compared to a control group (grade 0, SOS [–]).
Results
Of 286 patients, 175 were included. Preoperative factors were similar between the groups. Although not statistically significant, the SOS (+) group had a shorter chemotherapy-free interval before resection (7.96 weeks vs. 10.0 weeks, P = 0.069). The SOS (+) group had higher intraoperative blood loss (889.1 ± 1,126.6 mL vs. 555.3 ± 566.7 mL, P = 0.012) and transfusion rates (46.6% vs. 25.3%, P = 0.003). SOS correlated with increased liver surgery-specific complications (40.9% vs. 26.4, P = 0.043). Patients with SOS experienced adverse effects on intrahepatic recurrent-free survival and overall survival (5-year survival, 46.0% vs. 33.9%; P = 0.014).
Conclusion
SOS development during liver surgery is associated with increased intraoperative blood loss, transfusion volume, and liver surgery-specific complications and has a higher risk of early recurrence and decreased overall survival. Thus, it is crucial to exercise caution during liver surgery in these patients.

Keyword

Chemical and drug induced liver injury; Colorectal neoplasms; Drug therapy; Hepatectomy; Hepatic venoocclusive disease

Figure

• 

  Fig. 1 The summary of the study selection process. CRLM, colorectal liver metastasis; SOS, sinusoidal obstruction syndrome. *5-fluorouracil only, 5-fluorouracil and leucovorin only.

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  Fig. 2 Histological staining of liver tissue in sinusoidal obstruction syndrome (H&E). (A) Microscopic finding reveals a focal area of hepatocellular plate atrophy associated with mild sinusoidal dilation (×40). (B) Hemorrhage into markedly dilated sinusoids with hepatocyte necrosis is shown (×100).

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  Fig. 3 Kaplan-Mayer curve. (A) Proportional recurrence-free survival and (B) overall survival. SOS, sinusoidal obstruction syndrome.

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