The second patient required revision of hepaticojejunostomy 3 months after the initial surgery. One selleck 17-DMAG patient had a perioperative myocardial infarction requiring angioplasty and stenting during the same admission. There was one anastomotic dehiscence in the only patient who underwent a closure of ileostomy at the same time as his liver resection; this required a second surgical intervention. One patient had a small bowel obstruction which resolved with conservative management. The average liver function score as per Schindl et al.23 was 3 (moderate dysfunction). Only two patients developed severe liver dysfunction. In one case, the patient developed grade 3 hepatic encephalopathy after the second resection of a staged procedure. In addition, he developed jaundice (peak bilirubin 80 ��mol/l), elevation of INR (peak 1.

7) and elevation of lactic acid (peak 4.2). These returned to normal by postoperative day 7. In the second case, after an extended left hepatectomy, the patient developed jaundice (peak bilirubin 83.5 ��mol/l), elevation of INR (peak 1.8), and elevated lactic acid (peak 3.6). She developed a late leak from her hepaticojejunostomy, which was revised 3 months after the original surgery. Table 4 Postoperative complications Chemotherapy-associated toxicity Twenty-four patients (68%) demonstrated some degree of steatosis in the resection specimens, of which six cases (17.1%) were moderate. Only four patients (11.4%) had steatohepatitis in the resected liver (three mild, one moderate) and there were no cases of severe steatohepatitis.

No specimen demonstrated significant sinusoidal injury. Survival The median follow-up for this group of patients is 2.9 years. The Kaplan�CMeier calculated 4-year survival is 52.5%. Median survival has not yet been reached (Fig. 1). Figure 1 Survival after perioperative bevacizumab Discussion The frequency of perioperative treatment strategies in the treatment of CRLM continues to increase despite a relative lack of prospective data to support their use. Proponents of these strategies cite the opportunity to downsize tumours and in some cases render unresectable Dacomitinib tumours resectable, as well as the opportunity to identify non-responders to chemotherapy who are unlikely to benefit from surgical resection. Even among those who espouse the use of perioperative chemotherapy, there has been reluctance to add antiangiogenic agents for fear of increasing perioperative morbidity and mortality, especially when the primary tumour has not yet been resected. Certainly, there are reports of increased bleeding, delayed wound healing and even intestinal perforation associated with the use of Bev.