Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of Würzburg, Würzburg, Germany.
Department of General, Visceral and Transplantation Surgery, Charité -Universitätsmedizin Berlin, Berlin, Germany.
Ann Surg Oncol. 2017 Sep;24(9):2447-2455. doi: 10.1245/s10434-017-5887-2. Epub 2017 May 17.
Chemotherapy of colorectal liver metastases (CLMs) prior to liver resection implies the risk of chemotherapy-associated liver injury, leading to increased postoperative morbidity and mortality OBJECTIVE: The aim of this study was to evaluate the LiMAx (liver maximum capacity) test for diagnosis of chemotherapy-associated liver injury.
This was a retrospective analysis of patients with CLMs, prior to liver resection. We performed preoperative assessment of liver function using biochemical parameters and the LiMAx test. The individual history of chemotherapy within 12 months, including regimen, number of cycles, and therapy-free interval were collected, and histopathological evaluation of tumor-free liver tissue was performed in resected patients.
A total of 204 patients were included, of whom 127 (62%) had received previous chemotherapy. The LiMAx test was worse after chemotherapy (340 ± 95 vs. 391 ± 82 µg/kg/h; p < 0.001). Impaired LiMAx results (<315 µg/kg/h) were determined in 49% of patients after chemotherapy, and no effects of chemotherapy, liver steatosis or fibrosis on biochemical parameters were observed. LiMAx impairment was dependent on the number of oxaliplatin cycles, the therapy-free interval, and obesity in multivariate analysis. In addition, the LiMAx test was worse in patients with relevant steatosis, fibrosis and steatohepatitis. Patients with an impaired LiMAx showed sufficient regeneration during chemotherapy cessation when surgery was postponed (272 ± 57 - 348 ± 72 µg/kg/h; p = 0.003).
The LiMAx test enables non-invasive preoperative diagnosis of chemotherapy-associated liver injury. Preoperative performance of the LiMAx test can augment surgical strategy and timing of surgery after previous chemotherapy, thus avoiding increased postoperative morbidity.
结直肠癌肝转移（CLM）患者在接受肝切除术前进行化疗可能会导致化疗相关肝损伤，从而增加术后发病率和死亡率。目的：本研究旨在评估 LiMAx（肝脏最大容量）试验在诊断化疗相关肝损伤中的作用。
这是一项回顾性分析，纳入了 CLM 患者，这些患者在接受肝切除术前进行了肝功能评估。我们使用生化参数和 LiMAx 试验进行了术前评估。收集了患者在 12 个月内的化疗个人史，包括方案、周期数和无治疗间隔，并对切除患者的无肿瘤肝组织进行了组织病理学评估。
共纳入 204 例患者，其中 127 例（62%）接受过先前的化疗。化疗后 LiMAx 试验结果较差（340±95 比 391±82 µg/kg/h；p<0.001）。化疗后有 49%的患者出现 LiMAx 结果受损（<315 µg/kg/h），且未观察到化疗、肝脂肪变性或纤维化对生化参数的影响。在多变量分析中，LiMAx 受损与奥沙利铂周期数、无治疗间隔和肥胖有关。此外，LiMAx 试验在有相关脂肪变性、纤维化和脂肪性肝炎的患者中较差。当手术推迟时，LiMAx 受损的患者在化疗停止期间显示出足够的再生（272±57-348±72 µg/kg/h；p=0.003）。
LiMAx 试验可在术前进行非侵入性诊断化疗相关肝损伤。在接受过化疗的患者中，术前进行 LiMAx 试验可以增强手术策略和手术时机，从而避免术后发病率增加。
