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Obesity predictive of steatohepatitis, steatosis in patients with colorectal liver metastasis

Obese patients with colorectal liver metastasis were more likely to develop steatohepatitis or steatosis than nonobese patients in a recent study.

Researchers reviewed data from 208 patients with colorectal liver metastasis who underwent hepatic resection or combined resection and thermal ablation between 2001 and 2009, with a median follow-up of 32 months. Preoperative chemotherapy was administered in 75% of cases for a median duration of 4 months.

Differences were not significant between patients who did and did not receive chemotherapy regarding morbidity (21.2% of chemotherapy recipients vs. 18.6% of those without treatment; P=.412), mortality (1.3% vs. 1.9%; P=.58) or incidence of liver injury (23.7% vs. 17.3%; P=.465), including steatosis (13.5% vs. 11.5%; P=.332) and steatohepatitis (10.3% vs. 5.8%; P=.465).

Thirty-six percent of participants were obese, and 39% of them had either steatosis or steatohepatitis, compared with 12.8% of nonobese patients (P≤.001). Investigators noted that mortality and perioperative complication rates were not higher among obese patients, despite the higher incidence of liver injury. Preoperative chemotherapy was more common among obese participants (85.1% of cases vs. 69.4%; P=.012), but chemotherapy did not significantly alter liver injury incidence among obese patients (40% of chemotherapy recipients vs. 37% of nonrecipients; P=.79).

Multivariate analysis indicated that BMI of 30 or greater was predictive of liver injury (OR=3.88; 95% CI, 1.87-8.04), while other factors including age, sex, diabetes, sleep apnea, alcohol and tobacco use and the use of neoadjuvant chemotherapy were not. BMI also was independently predictive of chemotherapy-related liver injury among participants who received chemotherapy (P<.0001).

“The present study indicates that regardless of the use of preoperative chemotherapy, obesity is a major contributor to findings of liver injury in patients undergoing hepatectomy for colorectal liver metastasis,” the researchers concluded. “Although the histologic changes associated with obesity do not necessarily correlate with a worse overall outcome, they do merit increased caution in dealing with morbidly obese patients in terms of hepatic resection. Careful attention should be given to preoperative planning and assessment of the extent of tolerable resection.”