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Evaluation of Chemotherapy-Associated Liver Injury in Patients with Colorectal Cancer Liver Metastases Using Indocyanine Green Clearance Testing

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Systemic chemotherapy may render initially unresectable colorectal cancer liver metastases resectable. Histopathologic examinations of resected nontumoral liver tissue revealed chemotherapy-associated liver injuries, which was recognized to impair the function of the remnant liver. We therefore evaluated whether indocyanine green (ICG) plasma clearance helps to assess chemotherapy-induced liver damage.

Methods

Data of 101 liver resections performed between 2006 and 2008 for colorectal liver metastases were analyzed for this study. Eighteen patients had liver resection without preoperative treatment, whereas 83 patients underwent neoadjuvant chemotherapy before surgery. ICG clearance was assessed by pulse densitometry before surgery.

Results

Comparison of ICG retention clearances demonstrated that patients pretreated with systemic chemotherapy had a significantly lower plasma disappearance rate (ICG-PDR; 19.3 ± 5.9 vs. 23.1 ± 3.8%/min; P = 0.002) and a significantly elevated ICG retention rate at 15 min (7.9 ± 6.6 vs. 3.8 ± 1.9%; P < 0.001). The percentage of subjects with an abnormal ICG-PDR (≤18%/min) was significantly higher in the pretreated group (48.2% vs. 5.6%; P = 0.001). Patients with an ICG-PDR of ≤18 had a prolonged postoperative hospital stay and experienced four times more complications in their postoperative course.

Conclusions

ICG clearance helps to identify patients with impaired liver function after neoadjuvant chemotherapy and aids in the estimation of the postoperative risk of morbidity after liver resection for colorectal liver metastases.

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Acknowledgment

Supported in part by the Association of Research on the Biology of Liver Tumors.

Conflict of interest

The authors declare that they have no commercial interest in the subject of this study.

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Authors and Affiliations

  1. Department of General Surgery, Medical University of Vienna, Vienna, Austria

    Peter-Michael Krieger MD, Dietmar Tamandl MD, Beata Herberger BSc & Thomas Gruenberger MD

  2. Department of Anaesthesiology, Medical University of Vienna, Vienna, Austria

    Peter Faybik MD & Edith Fleischmann MD

  3. Department of Pathology, Medical University of Vienna, Vienna, Austria

    Judith Maresch MD

Authors
  1. Peter-Michael Krieger MD
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  2. Dietmar Tamandl MD
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  3. Beata Herberger BSc
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  4. Peter Faybik MD
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  5. Edith Fleischmann MD
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  6. Judith Maresch MD
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  7. Thomas Gruenberger MD
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Correspondence to Thomas Gruenberger MD.

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Krieger, PM., Tamandl, D., Herberger, B. et al. Evaluation of Chemotherapy-Associated Liver Injury in Patients with Colorectal Cancer Liver Metastases Using Indocyanine Green Clearance Testing. Ann Surg Oncol 18, 1644–1650 (2011). https://doi.org/10.1245/s10434-010-1494-1

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  • DOI: https://doi.org/10.1245/s10434-010-1494-1

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