Preoperative Biopsy Evaluation of Chemotherapy-Associated Liver Injuries

Abstract

We read with great interest the study by Viganò et al¹ regarding the use of preoperative biopsy to evaluate chemotherapy-associated liver injuries (CALIs). With the increasing use of preoperative chemotherapy, concern has grown that CALIs may be more prevalent and, in turn, adversely affect perioperative outcomes. Our group² has previously shown that patients who undergo a major hepatic resection in the setting of steatohepatitis are at risk for increased perioperative mortality. Other studies, however, found no association between simple steatosis or sinusoidal dilatation and outcome.^3,4 The prospective trial by the European Organisation for the Research and Treatment of Cancer examined the use of perioperative chemotherapy and found a small increase in perioperative complications in the treatment arm but no difference in mortality.⁵