Cancer Management and Research (May 2020)
Indocyanine Green Clearance Test for the Preoperative Assessment of Chemotherapy-Related Hepatic Injury in Patients with Colorectal Liver Metastasis
Abstract
Li-Jun Wang, Xiao-Luan Yan, Juan Li, Kun Wang, Bao-Cai Xing Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepatopancreatobiliary Surgery Unit I, Peking University Cancer Hospital & Institute, Beijing 100142, People’s Republic of ChinaCorrespondence: Bao-Cai XingKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepatopancreatobiliary Surgery Unit I, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian, Beijing 100142, People’s Republic of ChinaEmail [email protected]: The aim of the present study was to determine the value of the indocyanine green (ICG) clearance test in the preoperative assessment of chemotherapy-related hepatic injury in patients with liver metastasis from colorectal cancer.Methods: A total of 218 patients who underwent hepatic dissection due to colorectal cancer liver metastasis at the Peking University Cancer Hospital between January 2016 and December 2017 were retrospectively evaluated; 179 patients who received chemotherapy prior to hepatic resection were further examined. Patient- and chemotherapy-related factors were analyzed in both groups with normal and abnormal ICG retention rate at 15 min (ICG-R15), and their intraoperative and postoperative outcomes were compared.Results: The chemotherapy group had a higher mean ICG-R15 value and a higher number of patients who exhibited abnormal ICG-R15, compared with the no-chemotherapy group. Under the guidance of ICG test, no patients experienced severe complications in the abnormal ICG-R15 group compared with the normal ICG-R15 group, and the overall morbidity was also not significantly different between the two groups. However, the incidence of severe complications was higher in patients who underwent major resection with a normal ICG-R15 value compared with patients with an abnormal ICG-R15 value who underwent minor resection (P< 0.05). Multivariable logistic regression analyses revealed that body mass index (BMI) ≥ 28 and oxaliplatin use were independent predictors of abnormal ICG-R15. The ICG-R15 value was significantly higher in the two-risk factors group compared with the no-risk factor group (P=0.012), but not statistically different compared with the one risk factor group.Conclusion: Screening of patients with chemotherapy-associated liver injury using the IGC test may help in performing safe hepatectomy by avoiding major resection. BMI ≥ 28 and oxaliplatin use were independent preoperative predictors of abnormal ICG-R15.Keywords: indocyanine green, resection, liver metastasis, colorectal cancer, morbidity
