Johan F Lock1, Tilman Westphal2, Tom Rubin2, Maciej Malinowski3, Antje Schulz3, Maximilian Jara2, Jan Bednarsch4, Martin Stockmann2,5. 1. Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of Würzburg, Würzburg, Germany. lock_J@ukw.de. 2. Department of General, Visceral and Transplantation Surgery, Charité -Universitätsmedizin Berlin, Berlin, Germany. 3. Department of General, Visceral, Vascular and Pediatric Surgery, Saarland University Hospital, Homburg (Saar), Germany. 4. Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Rhine Westphalia Institute of Technology, Aachen, Germany. 5. Evangelisches Krankenhaus Paul Gerhardt Stift, Lutherstadt Wittenberg, Germany.
Abstract
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.
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.
Authors: Mirhasan Rahimli; Aristotelis Perrakis; Andrew A Gumbs; Mihailo Andric; Sara Al-Madhi; Joerg Arend; Roland S Croner Journal: J Clin Med Date: 2022-05-27 Impact factor: 4.964
Authors: M Stockmann; F W R Vondran; R Fahrner; H M Tautenhahn; J Mittler; H Bektas; M Malinowski; M Jara; I Klein; J F Lock Journal: BJS Open Date: 2018-06-14
Authors: Eva-Maria Wittauer; Felix Oldhafer; Eva Augstein; Oliver Beetz; Moritz Kleine; Carsten Schumacher; Lion Sieg; Hendrik Eismann; Kai Johanning; André Bleich; Florian Wolfgang Rudolf Vondran Journal: PLoS One Date: 2019-05-31 Impact factor: 3.240
Authors: Jan C Mahlmann; Thomas C Wirth; Björn Hartleben; Harald Schrem; Jens F Mahlmann; Alexander Kaltenborn; Jürgen Klempnauer; Ulf Kulik Journal: Visc Med Date: 2020-10-09