A prospective study of Change in Liver Function and Fat in patients with colorectal liver metastases undergoing pre-operative chemotherapy: protocol for the CLiFF study

Research output: Contribution to journalArticlepeer-review

  • External authors:
  • Kathryn Parmar
  • Derek O'Reilly
  • Michael Braun
  • William Lloyd
  • Lee Malcomson
  • Colin Bamford


Pre-operative chemotherapy in patients undergoing resection for colorectal liver metastases (CLM) improves oncological outcomes. However, chemotherapy-associated liver injury (occurring in two patterns: vascular and fat deposition) is a real clinical concern prior to hepatic resection. After major liver resection, regeneration of the residual liver is a prerequisite for recovery and avoidance of liver failure, but this regenerative capacity may be hindered by chemotherapy. Thus, there is a need to predict for this serious complication. Over the past two decades, several tests and derived indices have been developed, which
have failed to achieve clinical utility, mainly as they were indirect measurements of liver function. Here, we will use a novel test of liver function (the LiMAx test), and measure liver fat using magnetic resonance (MR) imaging.

Methods and analysis
This prospective study will assess changes in liver function longitudinally, measured by the LiMAx test, and liver fat, measured by advanced MR imaging using both MR spectroscopy and the modified Dixon method, in up to 35 patients undergoing pre-operative chemotherapy for CLM. The primary outcomes will be the changes in liver function and fat compared to baseline pre-chemotherapy measurements. Secondary outcome measures include: routinely
measured liver function blood tests, anthropometric measurements, post-operative histology and digital quantification of fat, post-operative complications and mortality and quality of life.

Bibliographical metadata

Original languageEnglish
JournalBMJ Open
Publication statusAccepted/In press - 23 Oct 2019