4 Vauthey et al. suggested to perform a preoperative diagnostic laparoscopy to identify a bluish appearance of the liver [5]. It could be postulated that, considering the hepato- toxicity of neoadjuvant chemotherapy, initial liver surgery followed by adjuvant chemotherapy might be the treatment of choice in patients with clearly resectable CLMs [15]. However, the eﬀects on disease-free and long-term survival should be evaluated in adequately powered randomized controlled trials. In case of unresectable or recurrent CLMs preoperatively treated with oxaliplatin-based chemotherapy, caution is recommended when an extensive hepatic resection is scheduled and SOS or NRH are suspected. Even if the time interval between chemotherapeutic treatment and surgical resection is long, SOS or NRH might still be present. Careful volumetric analysis of future remnant liver volume should guide the operative strategy. Either preoperative portal vein embolization and/or restrictive surgery should be considered when the future remnant liver volume is regarded insuﬃcient. The safety limit for future remnant liver volume after neoadjuvant chemotherapy treatment would be between 30% and 40%; however, this needs careful prospective validation. Future research should be focussed on assessment of the optimal duration of chemotherapeutic treatment and timing of liver surgery as well as the development of reliable scree- ning methods and strategies to protect the nontumorous liver from the deleterious eﬀects of neoadjuvant chemother- apy. References [1] E. K. Abdalla, R. Adam, A. J. Bilchik, D. Jaeck, J.-N. Vauthey, and D. Mahvi, “Improving resectability of hepatic colorectal metastases: expert consensus statement,” Annals of Surgical Oncology, vol. 13, no. 10, pp. 1271–1280, 2006. [2] B. Nordlinger, H. Sorbye, B. Glimelius, et al., “Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial,” The Lancet, vol. 371, no. 9617, pp. 1007–1016, 2008. [3] T. Aloia, M. Sebagh, M. Plasse, et al., “Liver histology and surgical outcomes after preoperative chemotherapy with ﬂuo- rouracil plus oxaliplatin in colorectal cancer liver metastases,” Journal of Clinical Oncology, vol. 24, no. 31, pp. 4983–4990, 2006. [4] L. Rubbia-Brandt, V. Audard, P. Sartoretti, et al., “Severe hepatic sinusoidal obstruction associated with oxaliplatin- based chemotherapy in patients with metastatic colorectal cancer,” Annals of Oncology, vol. 15, no. 3, pp. 460–466, 2004. [5] J.-N. Vauthey, T. M. Pawlik, D. Ribero, et al., “Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases,” Journal of Clinical Oncology, vol. 24, no. 13, pp. 2065–2072, 2006. [6] H. Nakano, E. Oussoultzoglou, E. Rosso, et al., “Sinu- soidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy,” Annals of Surgery, vol. 247, no. 1, pp. 118–124, 2008. Case Reports in Medicine [7] C. H. Dejong and O. J. Garden, “Neoplasms of the liver,” in Advances in Surgical Practice, A. A. Majid and A. Kingsnorth, Eds., pp. 146–156, Greenwich Medical Media, London, UK, 2003. [8] Y. Fong and D. J. Bentrem, “CASH (chemotherapy-associated steatohepatitis) costs,” Annals of Surgery, vol. 243, no. 1, pp. 8–9, 2006. [9] L. D. DeLeve, H. M. Shulman, and G. B. McDonald, “Toxic injury to hepatic sinusoids: sinusoidal obstruction syndrome (veno-occlusive disease),” Seminars in Liver Disease, vol. 22, no. 1, pp. 27–42, 2002. [10] K. Washington, K. L. Lane, and W. C. Meyers, “Nodular regenerative hyperplasia in partial hepatectomy specimens,” American Journal of Surgical Pathology, vol. 17, no. 11, pp. 1151–1158, 1993. [11] I. R. Wanless, “Micronodular transformation (nodular regen- erative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classiﬁcation of benign hepatocel- lular nodules,” Hepatology, vol. 11, no. 5, pp. 787–797, 1990. [12] P. A. Reshamwala, D. E. Kleiner, and T. Heller, “Nodular regenerative hyperplasia: not all nodules are created equal,” Hepatology, vol. 44, no. 1, pp. 7–14, 2006. [13] L. D. DeLeve, “Hepatic microvasculature in liver injury,” Seminars in Liver Disease, vol. 27, no. 4, pp. 390–400, 2007. [14] E. Schiﬀer, J.-L. Frossard, L. Rubbia-Brandt, G. Mentha, and C. M. Pastor, “Hepatic regeneration is decreased in a rat model of sinusoidal obstruction syndrome,” Journal of Surgical Oncology, vol. 99, no. 7, pp. 439–446, 2009. [15] A. J. Bilchik, G. Poston, S. A. Curley, et al., “Neoadjuvant chemotherapy for metastatic colon cancer: a cautionary note,” Journal of Clinical Oncology, vol. 23, no. 36, pp. 9073–9078, 2005.