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01.10.2010 | Hepatobiliary Tumors | Ausgabe 10/2010

Annals of Surgical Oncology 10/2010

Recovery of Liver Function After the Cessation of Preoperative Chemotherapy for Colorectal Liver Metastasis

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 10/2010
Autoren:
MD Takeshi Takamoto, MD, PhD Takuya Hashimoto, MD, PhD Keiji Sano, MD Yoshikazu Maruyama, MD, PhD Kazuto Inoue, MD, PhD Satoshi Ogata, MD, PhD Tamiko Takemura, MD, PhD Norihiro Kokudo, MD, PhD Masatoshi Makuuchi

Abstract

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 2–4 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 R15 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.

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