Tani Keigo, Shindoh Junichi, Takamoto Takeshi, Shibahara Junji, Nishioka Yujiro, Hashimoto Takuya, Sakamoto Yoshihiro, Hasegawa Kiyoshi, Makuuchi Masatoshi, Kokudo Norihiro
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Hepatobiliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
J Gastrointest Surg. 2017 May;21(5):813-821. doi: 10.1007/s11605-017-3359-4. Epub 2017 Jan 12.
Total liver volume (TLV) empirically changes after aggressive preoperative chemotherapy for colorectal liver metastases (CLM). However, the actual degree of changes in normal liver parenchyma and its clinical relevance remain unclear.
Morphometric data of 110 patients who underwent initial hepatectomy after preoperative chemotherapy were reviewed. TLVs before and after chemotherapy were measured using a computer-based volumetry software and their relevance to clinical factors was investigated.
More than 10% of decrease in TLV was observed in 42 (38.2%) patients, and more than 10% of increase was observed in 11 (10.0%) patients. Change in TLV was within 10% in the remaining 57 (51.8%) patients. Indocyanine green retention rate at 15 min (ICG-R15) value was significantly higher in patients with TLV decrease more than 10% (13.4 vs. 9.3 vs. 8.5%; p = 0.004). Steatosis in the underlying liver was significantly frequent in patients with TLV increase more than 10% (p < 0.001). Multivariate logistic regression analysis revealed that more than 10% of shrinkage in TLV after chemotherapy was independently associated with ICG-R15 >15% (odds ratio 8.8; p = 0.0001). Tendency of correlation was confirmed in the kinetic changes in TLV and ICG-R15 during chemotherapy even though there was no statistical significance (r = -0.33, p = 0.080).
Perichemotherapy kinetic changes in TLV may predict histopathologic changes or changes in hepatic functional reserve in the underlying liver. More than 10% of shrinkage in TLV is associated with impaired hepatic functional reserve, and it can be a new supplemental finding in the prediction of surgical risk of major hepatectomy for CLM.
对结直肠癌肝转移（CLM）患者进行积极的术前化疗后，全肝体积（TLV）会根据经验发生变化。然而，正常肝实质的实际变化程度及其临床相关性仍不清楚。
回顾了110例术前化疗后接受初次肝切除术患者的形态学数据。使用基于计算机的容积测量软件测量化疗前后的TLV，并研究其与临床因素的相关性。
42例（38.2%）患者的TLV下降超过10%，11例（10.0%）患者的TLV增加超过10%。其余57例（51.8%）患者的TLV变化在10%以内。TLV下降超过10%的患者15分钟吲哚菁绿滞留率（ICG-R15）值显著更高（分别为13.4%、9.3%和8.5%；p = 0.004）。TLV增加超过10%的患者肝脏脂肪变性明显更常见（p < 0.001）。多因素逻辑回归分析显示，化疗后TLV缩小超过10%与ICG-R15>15%独立相关（比值比8.8；p = 0.0001）。化疗期间TLV和ICG-R15的动态变化中虽无统计学意义，但证实了相关性趋势（r = -0.33，p = 0.080）。
化疗期间TLV的动态变化可能预测潜在肝脏的组织病理学变化或肝功能储备变化。TLV缩小超过10%与肝功能储备受损相关，它可能是预测CLM肝大部切除术手术风险的一项新的补充发现。
