Published October 2009br/br/bSummary:/b Bowel cancer commonly spreads to the liver. In most patients this cannot be removed by an operation and cure is not possible. Chemotherapy treatment can help control the growth of the cancer and improve survival. Radioactive beads can be injected into the blood vessels of the liver to try and control the cancer in the liver. In one study that had 21 participants, radioactive beads (injected into the blood vessels of the liver) given with chemotherapy (into the veins of the arm) was more effective at controlling the cancer and improving how long people lived than chemotherapy given on it's own. However, in this study more people who received the radioactive beads suffered from side effects and this study used an older type of chemotherapy that is less effective than the newer treatments that are now available. In a second study with 63 participants, radioactive beads were given with chemotherapy that was injected directly into the blood vessels of the liver. In this study there was no extra benefit in the control of cancer growth or survival for those participants who received radioactive beads in addition to the chemotherapy. More studies are needed with a particular focus on whether radioactive beads provides extra benefit when given with newer chemotherapy treatments, and if radioactive beads provide benefit when given on their own.

Published October 2009 br/br/b Summary:/b Elective liver surgery undertaken for a variety of reasons may require occlusion of the blood supply to the liver in order to reduce bleeding from the cut liver surface. This temporary blood supply interruption can cause liver damage for a variety of reasons. In experimental studies many drugs have shown some promise in decreasing liver damage caused by the occluded blood supply. We identified a total of 15 randomised trials evaluating 11 different pharmacological interventions (methylprednisolone, multivitamin antioxidant infusion, vitamin E infusion, amrinone, prostaglandin E1, pentoxifylline, mannitol, trimetazidine, dextrose, allopurinol, and OKY 046). All trials had risk of bias ('systematic errors') and risk of play of chance ('random errors'). There was no significant difference between the groups in mortality, liver failure, or post-operative complications. The trimetazidine group had a significantly shorter hospital stay, and the vitamin E group had a significantly shorter intensive therapy unit stay than the respective controls. There was no significant difference in any of the clinically relevant outcomes in the remaining comparisons. Methylprednisolone improved the enzyme markers of liver function and trimetazidine, methylprednisolone, and dextrose reduced the enzyme markers of liver injury compared to controls. However, there is a high risk of type I and type II errors because of the few trials included, the small sample size in each trial, and the risks of bias. Three pharmacological drugs - trimetazidine, methylprednisolone, and dextrose - have potential for a protective role against liver injury in elective liver surgery involving blood supply occlusion. However, based on the current evidence it is recommended that the use of these agents should be restricted to well-designed trials in patients undergoing resection.

Published October 2009br/br/b Summary:/b Blood loss during liver resection (partial removal of liver) is one of the important factors affecting the post-operative complications of patients. Allogeneic blood transfusion (using blood donated by a different individual) is associated with increased morbidity and lower survival in patients with liver cancer. This systematic review was aimed at determining whether any medical treatment decreased blood loss and decreased allogeneic blood transfusion requirements in patients undergoing liver resections. This systematic review included six trials with 849 patients. All trials had high risk of bias as well of play of chance. The trials included comparison of medicines with controls. There was no difference in the death or complications due to surgery or long-term survival in any of the comparisons. Fewer patients required transfusion of blood donated by others when aprotinin or tranexamic acid were compared to controls not receiving the interventions. The other comparisons did not decrease the transfusion requirements. However, there is a high risk of type I and type II errors because of the few trials included and the small sample size in each trial as well as the inherent risk of bias. Aprotinin and tranexamic acid show promise in the reduction of blood transfusion requirements in liver resections. Further randomised clinical trials with low risk of bias and low risk of play of chance which assess clinically important outcomes are necessary to assess any pharmacological interventions aimed at decreasing blood transfusion and blood transfusion requirements in liver resections. Trials need to be designed to assess the effect of a combination of different interventions in liver resections.

Published October 2009br/br/b Summary:/b Elective liver surgery undertaken for a variety of reasons may require occlusion of the blood supply to the liver in order to reduce bleeding from the cut liver surface. This temporary interruption of blood supply causes liver damage for a variety of reasons. In experimental studies many drugs have shown some promise in decreasing liver damage caused by the occluded blood supply. The relative benefits of pharmacological agents compared with one another is unknown in the setting of liver damage caused by occlusion of the blood supply to the liver during surgery. We identified a total of five randomised trials evaluating nine different pharmacological interventions. All trials had risk of bias and risk of play of chance. There was no significant difference between the groups in mortality, liver failure, or postoperative complications. The ulinastatin group had significantly lower postoperative enzyme markers of liver injury compared with the gantaile group. None of the remaining pharmacological agents showed any significant difference in any of the remaining outcomes. However, there is a high risk of type I and type II errors because of the few trials included, the small sample size in each trial, and the risk of bias. Ulinastatin may have a protective effect relative to gantaile against liver injury sustained during elective liver surgery involving blood supply occlusion. The absolute benefit of ulinastatin in this setting remains unknown. None of the pharmacological agents can be recommended for routine clinical practice. Considering that none of the agents have been proven to be useful to decrease ischaemia reperfusion injury, such trials should include a group of patients who do not receive any active intervention whenever possible to determine their absolute effect on ischaemia reperfusion injury in liver resections.

Published October 2009br/br/ bSummary:/b Hepatitis is inflammatory injury of the liver. Alcohol is toxic to the liver, and too much alcohol can cause alcoholic hepatitis. The severe form of alcoholic hepatitis is life-threatening. The use of pentoxifylline as a treatment for alcoholic hepatitis cannot be supported or rejected based on the best evidence available today. We found five randomised trials, which together included 336 participants; half received pentoxifylline, and the other half received placebo or no intervention. We performed this systematic review and statistical analyses but could not show firm evidence of beneficial effects of pentoxifylline on mortality or on complications of liver diseases in patients with alcoholic hepatitis. Pentoxifylline did appear to cause more serious and non-serious side effects. In order to help decide whether pentoxifylline should be used to treat alcoholic hepatitis or not, we need well-designed, well-conducted, large randomised clinical trials, with short-term (less than one month) and long-term (more than one month) data on benefits and harms.

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Published 20 August 2009br/br/bSummary:/b Several newspapers reported today that cases of liver cancer have tripled. The Mirror said that alcohol is to blame, as well as obesity and the blood infection hepatitis C. It reports that all three cause cirrhosis (scarring) of the liver, a condition that can develop into liver cancer. It said the “startling” figures from Cancer Research UK show that the number of cases of liver cancer has risen to 3,108 in 2006 from 865 in 1975.

Published 12 August 2009br/br/bSummary:/b “Two soft drinks a day may lead to long term liver damage”, The Daily Telegraph has reported. The newspaper said that a new study has found that, like the known risks that alcohol poses to the liver, fizzy drinks with a high sugar content can increase a person’s risk of developing fatty liver disease.

A structured abstract written by CRD reviewers. The abstract was published on 22 July 2009 from an original article published in 2007.

A structured abstract written by CRD reviewers. The abstract was published on 5 August 2009 from an original article published in 2008.