The influence of chemotherapy-associated sinusoidal dilatation on short-term outcome after partial hepatectomy for colorectal liver metastases: A systematic review with meta-analysis

- Oxaliplatin-based chemotherapy is associated with hepatic sinusoidal dilatation (SD).
- SD is not related to the incidence of morbidity and mortality after liver resection.
- Evidence per outcome was assessed with standardized risk of bias and quality tools.
- Quality of evidence for the relation between SD and outcomes was rated 'very poor'.
- This urges the use of uniform endpoints in future studies on surgical oncology.

Summary background dataHepatic sinusoidal dilatation (SD) is a histopathological entity that occurs in up to 75% of patients undergoing oxaliplatin-based chemotherapy for colorectal liver metastases (CRLM).ObjectiveTo study the influence of SD on outcome after partial hepatectomy in patients with CRLM.MethodsMedline, Embase, CENTRAL, LILACS and CINAHL were searched for studies published between 01.01.2004 and 09.06.2015 with keywords: “sinusoidal obstruction syndrome”, “hepatic veno-occlusive disease”, and “Stuart-Bras syndrome”. Studies comprising adults who underwent partial hepatectomy for CRLM with grading of SD and registration of postoperative morbidity and/or mortality were included. Risk of bias and quality of studies were evaluated with the Quality In Prognosis Studies Instrument (QUIPS) and modified GRADE framework.ResultsSearch strategies produced 2007 hits from which 23 and 13 articles were extracted for qualitative and quantitative analyses, respectively. Meta-analysis on the influence of SD grade 2-3 vs. SD grade 0-1 on postoperative overall morbidity showed an odds ratio (OR) of 1.26 [95% CI 0.74, 2.15](p = 0.40), an OR of 1.03 [0.15, 6.89](p = 0.98) for liver failure, an OR of 1.21 [0.23, 6.35](p = 0.82) for overall mortality, and an OR of 3.52 [0.31, 39.91](p = 0.31) for liver-related morbidity. QUIPS showed a low to high risk of bias for studies, and GRADE showed very low quality of evidence per outcome.ConclusionsNo significant effect of SD grade 2-3 on short-term outcome after partial hepatectomy was found. However, the data on which this conclusion was based were not very robust and therefore no solid conclusions could be drawn.