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Introduction Recent data have suggested that oxaliplatin-associated sinusoidal injury (SI) in the non-tumour bearing liver (NTBL) may be associated with adverse long-term outcome following hepatectomy for colorectal liver metastases (CRLM), though this observation may be an epiphenomenon of associations with unfavourable tumour biology. This study aimed to assess the impact of NTBL histology upon long-term outcome in a series of consecutive patients undergoing right hepatic trisectionectomy for CRLM. Methods Clinicopathological data for patients undergoing right trisectionectomy at a UK tertiary referral hepatobiliary centre between January 2002 and December 2008 were obtained from a prospectively maintained database. Blinded NTBL pathological review was conducted by two pathologists using established criteria for SI, steatosis, non-alcoholic steatohepatitis, fibrosis and cholestasis. Univariate and multivariable Cox regression analyses were performed to correlate perioperative and pathological variables with long-term overall and disease-free survival. Postoperative deaths (90-day) were excluded from long-term survival analyses. Results A total of 66 consecutive patients underwent right trisectionectomy for CRLM over the study period. Preoperative oxaliplatin-based chemotherapy was used in 24 cases (36.4%, median 6 cycles, range 2–8 cycles). SI was noted in 21 cases (31.8%) and was independently associated with oxaliplatin use. 5-Year overall survival rate was 28.8%. On multivariable analysis, number of metastases resected and SI were independently associated with shortened overall survival following trisectionectomy. Number of metastases resected, perioperative blood transfusion and SI were independently associated with shortened disease-free survival following trisectionectomy. Steatosis, non-alcoholic steatohepatitis, fibrosis and cholestasis showed no association with long-term survival. Conclusion Short-course oxaliplatin-associated SI is associated with adverse prognosis following right trisectionectomy for CRLM. The inclusion of traditional clinicopathological variables as covariates suggests that this finding is unlikely to simply be an epiphenomenon of associations with unfavourable tumour biology. Further studies are necessary to confirm these findings and to explore the underlying mechanism(s). Competing interests None declared.

Introduction Non-anatomic resections (NAR) for colorectal liver metastases (CRLM) have become increasingly common in an attempt to increase resection rates and to enable parenchyma-preserving resections, though some investigators have reported NAR to be associated with higher rates of resection margin positivity and poorer long-term survival than anatomic resections (AR). The aim of this study was to compare surgical outcomes, recurrence and survival in patients treated with NAR and AR. Methods Patients undergoing hepatic resection for CRLM between January 2002 and December 2008 were identified from a prospectively maintained database. Patients were divided into two groups: those who underwent AR and those who underwent NAR. Patients who underwent simultaneous AR and NAR were excluded from analysis. Clinicopathological variables and perioperative outcomes, as well as long-term disease-free and overall survival were compared between the AR and NAR groups, using the χ 2 test, Mann–Whitney U test, logistic regression analysis, log-rank analysis and multivariable Cox regression analysis employing a backwards stepwise model. Results Over the study period 91 patients underwent AR and 77 patients underwent NAR. Perioperative (90-day) morbidity, major morbidity and mortality occurred in 25.0%, 8.3% and 1.8% of cases respectively. There was no significant difference in rates of perioperative morbidity, major morbidity or mortality according to resection type (all p>0.30). There was also no difference in the incidence of positive resection margins between resection types (p=0.413). Overall survival was 48.5% and 36.6% at 3 and 5 years respectively, with disease-free survival of 31.4% and 25.3% at 3 and 5 years respectively. Type of resection was not associated with any significant difference in overall (p=0.430) or disease-free survival (p=0.625) following metastasectomy. Conclusion AR is not superior to NAR in terms of perioperative risk, tumour clearance, time to recurrence or long-term survival following metastasectomy. NAR should remain an integral component of the surgical treatment of CRLM and may enable increasing rates of operability. Furthermore, the preservation of hepatic parenchyma by NAR may enable a larger proportion of patients subsequently developing recurrent metastatic disease to undergo repeat metastasectomy. Competing interests None declared.