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Invited Critique
Dec 2012

Preoperative Biopsy Evaluation of Chemotherapy-Associated Liver Injuries: Looking for a Needle in a Haystack?
Comment on “Prospective Evaluation of Accuracy of Liver Biopsy Findings in the Identification of Chemotherapy-Associated Liver Injury”

Author Affiliations

Author Affiliations: Departments of Surgery, The Johns Hopkins University, Baltimore, Maryland (Dr Pawlik), and The University of Texas MD Anderson Cancer Center, Houston (Dr Vauthey).

Arch Surg. 2012;147(12):1092. doi:10.1001/archsurg.2012.1874

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

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