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

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

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.

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Author information

Authors and Affiliations

  1. Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of Würzburg, Würzburg, Germany

    Johan F. Lock MD

  2. Department of General, Visceral and Transplantation Surgery, Charité -Universitätsmedizin Berlin, Berlin, Germany

    Tilman Westphal MD, Tom Rubin PhD, Maximilian Jara MD & Martin Stockmann MD, PhD

  3. Department of General, Visceral, Vascular and Pediatric Surgery, Saarland University Hospital, Homburg (Saar), Germany

    Maciej Malinowski MD & Antje Schulz MD

  4. Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, Rhine Westphalia Institute of Technology, Aachen, Germany

    Jan Bednarsch MD

  5. Evangelisches Krankenhaus Paul Gerhardt Stift, Lutherstadt Wittenberg, Germany

    Martin Stockmann MD, PhD

Authors
  1. Johan F. Lock MD
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  2. Tilman Westphal MD
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  3. Tom Rubin PhD
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  4. Maciej Malinowski MD
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  5. Antje Schulz MD
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  6. Maximilian Jara MD
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  7. Jan Bednarsch MD
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  8. Martin Stockmann MD, PhD
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Corresponding author

Correspondence to Johan F. Lock MD.

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Conflicts of interest

Martin Stockmann is the inventor of the LiMAx test and has capital interest in Humedics, the company marketing the LiMAx test. Johan Lock receives revenues as a medical consultant of Humedics. Tilman Westphal, Tom Rubin, Maciej Malinowski, Antje Schulz, Maximilian Jara, and Jan Bednarsch have no conflicts of interest to declare.

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Lock, J.F., Westphal, T., Rubin, T. et al. LiMAx Test Improves Diagnosis of Chemotherapy-Associated Liver Injury Before Resection of Colorectal Liver Metastases. Ann Surg Oncol 24, 2447–2455 (2017). https://doi.org/10.1245/s10434-017-5887-2

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  • DOI: https://doi.org/10.1245/s10434-017-5887-2

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