Wakiya Taiichi, Kudo Daisuke, Toyoki Yoshikazu, Ishido Keinosuke, Kimura Norihisa, Narumi Shunji, Kijima Hiroshi, Hakamada Kenichi
Ann Surg Oncol. 2014 Jan;21(1):167-72. doi: 10.1245/s10434-013-3203-3.
The indocyanine green (ICG) clearance test is reported to be useful for the preoperative evaluation of hepatic functional reserve. However, the ICG clearance test has not been sufficiently investigated in patients with colorectal liver metastasis after chemotherapy. The aim of the present study was to evaluate whether the ICG clearance test is a useful parameter for the preoperative detection of chemotherapy-associated liver injury.
Ninety-four patients undergoing liver resection for colorectal liver metastasis after chemotherapy were studied. The medical records for each case were retrospectively reviewed. They underwent pathological assessment to clarify the degree of histopathological liver injury of the nontumoral liver parenchyma. In addition, the correlation between the pathological score and the ICG retention rate at 15 min (ICG-R15) was analyzed.
Sinusoidal injury was observed in the 31 of 94 patients. Steatohepatitis was observed in the 40 of 94 patients. There was no strong correlation between the preoperative ICG-R15 value and the sinusoidal pathological score (r = 0.117, P = 0.261). There was no strong correlation between the ICG-R15 and the nonalcoholic fatty liver disease activity score (r = 0.215, P = 0.037).
It was difficult to predict the degree of chemotherapy-associated liver injury by the preoperative ICG-R15 value. It is necessary to estimate the hepatic functional reserve based on a combination of several clinical indicators without relying on the ICG test, in order to perform a safe radical liver resection.
据报道，吲哚菁绿（ICG）清除试验有助于肝储备功能的术前评估。然而，对于化疗后结直肠癌肝转移患者，ICG清除试验尚未得到充分研究。本研究的目的是评估ICG清除试验是否是术前检测化疗相关肝损伤的有用参数。
对94例化疗后行肝切除治疗结直肠癌肝转移的患者进行研究。对每个病例的病历进行回顾性分析。他们接受了病理评估，以明确非肿瘤性肝实质的组织病理学肝损伤程度。此外，分析了病理评分与15分钟时ICG滞留率（ICG-R15）之间的相关性。
94例患者中有31例观察到窦性损伤。94例患者中有40例观察到脂肪性肝炎。术前ICG-R15值与窦性病理评分之间无强相关性（r = 0.117，P = 0.261）。ICG-R15与非酒精性脂肪性肝病活动评分之间无强相关性（r = 0.215，P = 0.037）。
术前ICG-R15值难以预测化疗相关肝损伤的程度。为了进行安全的根治性肝切除，有必要在不依赖ICG试验的情况下，结合多种临床指标来评估肝储备功能。
