ABSTRACT
Steatohepatitis An increased rate of steatohepatitis in patients undergoing preoperative chemotherapy was first observed by Fernandez et al. ( 28 ). Multivariate analysis showed that treatment with irinotecan or oxaliplatin and high BMI were independent risk
factors for steatohepatitis. In the previously mentioned study, Vauthey et al. ( 9 ) analyzed the relationship between preoperative chemotherapy and liver injury. Using the Kleiner’s score ( 19 ), 8% of the patients had steatohepatitis. Steatohepatitis rate was higher in those patients treated with irinotecan-based chemotherapy (20% vs. 4%, p < 0.001). The incidence of steatohepatitis was higher in patients with BMI higher than 25 kg/m 2 . The 90-day mortality rate for patients with steatohepatitis was 15%, compared to 2% for patients without steatohepatitis ( p = 0.001). The main cause of death was liver failure. The conclusion of the study was to cautiously use irinotecan in patients with BMI higher than 25 kg/m 2 , especially in patients undergoing major hepatic resections ( Table 18.1 ). Unlike simple steatosis, which does not significantly impact postoperative outcome, steatohepatitis is an ominous finding and a relative contraindication to major liver resection. Given the associations between irinotecan, steatohepatitis, and increased postoperative mortality, major hepatic resection should probably not be performed in patients with known steatohepatitis, and irinotecan should be avoided in patients with known steatosis or steatohepatitis or the features of metabolic syndrome if major hepatic resection is anticipated.
