Impact of metabolic liver disease on colorectal cancer and liver metastases: Pathophysiology and implications for hepatobiliary surgery

作者：Schmitz SM, Grünwald BT, Tasdogan A, Heise D, Bednarsch J, Heij LR, Reschke MA, Ulmer TF, Neumann UP, Lang SA · 发表于：Clinics and research in hepatology and gastroenterology · 年份：2026 · DOI：10.1016/j.clinre.2026.102853 · 研究领域：Colorectal cancer、Colorectal liver metastasis、Liver surgery、MASLD、Steatosis

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing globally and affects a growing proportion of patients with colorectal cancer (CRC). Beyond shared risk factors such as obesity and metabolic syndrome, MASLD appears to actively shape a pro-metastatic hepatic microenvironment, with important implications for colorectal liver metastases (CRLM), particularly in the surgical setting. METHODS: This narrative review synthesizes epidemiologic, mechanistic, imaging, and clinical data on the interplay between MASLD and CRC/CRLM, with a focus on hepatobiliary surgical relevance. RESULTS: MASLD is associated with increased risks of colorectal adenomas and CRC. Key mechanisms contributing to a pro-metastatic hepatic niche include insulin resistance, adipokine dysregulation, gut-liver endotoxemia with TLR4/NF-κB activation, chronic inflammation, fibrosis and extracellular matrix remodeling, and oxidative stress. Clinically, steatohepatitis and fibrosis are linked to higher perioperative morbidity, postoperative liver failure, and worse short-term outcomes after hepatectomy, whereas simple steatosis shows heterogeneous associations with survival. Chemotherapy-associated liver injury frequently overlaps with MASLD. In addition, MASLD reduces CT sensitivity for small hepatic lesions, while abbreviated non-contrast MRI improves surveillance. CONCLUSIONS: MASLD is a clinically relevant modifier of CRLM biology and surgical risk. Early identification, ...