LiMAx Test Improves Diagnosis of Chemotherapy-Associated Liver Injury Before Resection of Colorectal Liver Metastases

Background 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 diag...

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Bibliographic Details
Published in:	Annals of surgical oncology Vol. 24; no. 9; pp. 2447 - 2455
Main Authors:	Lock, Johan F., Westphal, Tilman, Rubin, Tom, Malinowski, Maciej, Schulz, Antje, Jara, Maximilian, Bednarsch, Jan, Stockmann, Martin
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 01-09-2017 Springer Nature B.V
Subjects:	Acetamides - metabolism Aged Algorithms Antineoplastic Agents - administration & dosage Antineoplastic Agents - adverse effects Chemical and Drug Induced Liver Injury - diagnosis Chemical and Drug Induced Liver Injury - pathology Chemical and Drug Induced Liver Injury - physiopathology Chemotherapy Chemotherapy, Adjuvant - adverse effects Colorectal Neoplasms - pathology Diagnosis Fatty liver Fatty Liver - pathology Fatty Liver - physiopathology Female Fibrosis Hepatobiliary Tumors Humans Liver Liver Cirrhosis - pathology Liver Cirrhosis - physiopathology Liver Function Tests Liver Neoplasms - drug therapy Liver Neoplasms - secondary Liver Neoplasms - surgery Male Medicine Medicine & Public Health Metastases Metastasis Middle Aged Morbidity Multivariate analysis Neoadjuvant Therapy - adverse effects Obesity - physiopathology Oncology Organoplatinum Compounds - administration & dosage Organoplatinum Compounds - adverse effects Oxaliplatin Preoperative Period Retrospective Studies Steatosis Surgery Surgical Oncology Survival Rate Time Factors Liver Fibrosis Colorectal Liver Metastasis Liver Resection Portal Vein Embolization Liver Steatosis
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Summary:	Background 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. Methods 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. Results 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). Conclusion 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1068-9265 1534-4681
DOI:	10.1245/s10434-017-5887-2