Recovery of Liver Function After the Cessation of Preoperative Chemotherapy for Colorectal Liver Metastasis
Recovery of Liver Function After the Cessation of Preoperative Chemotherapy for Colorectal Liver Metastasis
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DOI：
10.1245/s10434-010-1074-4
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发表时间：
2010-10-01
影响因子：
3.7
通讯作者：
Makuuchi, Masatoshi
中科院分区：
文献类型：
--
作者：
Takamoto, Takeshi;Hashimoto, Takuya;Makuuchi, Masatoshi
背景含奥沙利铂（FOLFOX）或伊立替康（FOLFIRI）的术前化疗可导致结直肠癌肝转移（CRLM）患者的组织学肝损伤，并增加术后发病率和死亡率。然而，关于肝功能恶化及其可逆性的信息很少。本研究共纳入了55例接受FOLFOX和/或FOLFIRI后接受肝切除术的患者。在肝切除术前反复进行吲哚菁绿色试验，监测肝储备功能的变化。与2周内记录的结果（16.8%）相比，在末次化疗后2-4周（12.9%，P = 0.04）、4-8周（11.4%，P = 0.01）和8周或更长时间（11.1%，P = 0.006）观察到ICG R15值显著降低。然而，在24周、4-8周和8周或更长时间获得的值中未观察到显著变化。个体ICG R15值在戒烟期开始和结束时也从17.7%改善至11.6%（P = .001）。组织学肝损伤与大量手术失血有关，但与发病率无关。在本系列中，没有发生肝衰竭或死亡。以ICG R 15值为代表的肝脏储备功能在化疗停止后的一段时间内得到改善。目前的研究表明，化疗停止至少2-4周可以改善肝储备功能，特别是在接受6个或更多周期FOLFOX和/或FOLFIRI的ICG R15值异常（> 10%）的患者中。
Background. Preoperative chemotherapy containing oxaliplatin (FOLFOX) or irinotecan (FOLFIRI) causes histological liver injury and increases postoperative morbidity and mortality in patients with colorectal liver metastasis (CRLM). However, information on the aggravation of liver function and its reversibility is scarce.Methods. A total of 55 patients who underwent a hepatectomy after receiving FOLFOX and/or FOLFIRI were included in the present study. Indocyanine green tests were repeatedly performed before hepatectomy for monitoring the change of hepatic functional reserve.Results. A significant decrement in the ICG R15 value was observed at 2-4 weeks (12.9%, P = .04), 4-8 weeks (11.4%, P = .01), and 8 or more weeks (11.1%, P = .006) after the last chemotherapy, compared with results documented within 2 weeks (16.8%). However, no significant change was observed among the values obtained at 24 weeks, 4-8 weeks, and 8 or more weeks. The individual ICG R15 values at the beginning and end of the cessation period also improved from 17.7% to 11.6% (P = .001). Histological liver injury was associated with larger amounts of operative blood loss but not with morbidity. Neither liver failure nor mortality occurred in the present series.Conclusions. The hepatic functional reserve, represented by the ICG R 15 value, improves during the period after chemotherapy cessation. The present study suggests that chemotherapy cessation for at least 2-4 weeks enables an improvement in the hepatic functional reserve, especially among patients with an abnormal ICG R15 value (> 10%) who have received 6 or more cycles of FOLFOX and/or FOLFIRI.