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. 2025 Jun 1;14(3):411-422.
doi: 10.21037/hbsn-24-121. Epub 2024 Sep 18.

Splenic hypertrophy predicts liver-specific complications in patients undergoing major liver resection for colorectal liver metastases, after preoperative chemotherapy

Gerrit Josephs  1 , Lea Hitpass  2 , Daniel Truhn  2 , Franziska Meister  1 , Marie-Luise Berres  3 , Tom Luedde  4 , Danny Jonigk  5   6 , Steven W M Olde Damink  7 , Sven Arke Lang  8 , Florian Vondran  1 , Iakovos Amygdalos  1
Affiliations

Splenic hypertrophy predicts liver-specific complications in patients undergoing major liver resection for colorectal liver metastases, after preoperative chemotherapy

Gerrit Josephs et al. Hepatobiliary Surg Nutr. .

Abstract

Background: In patients with colorectal liver metastases (CRLM), preoperative chemotherapy may increase resectability and survival outcomes. However, cytotoxic agents can also cause chemotherapy-associated liver injury (CALI), leading to increased rates of postoperative complications. This study evaluates the association between splenic hypertrophy (SH) after preoperative chemotherapy and postoperative liver-specific complications (LSC), in patients undergoing major liver resection for CRLM.

Methods: This retrospective study included patients who underwent major curative liver resection of CRLM following preoperative chemotherapy at the University Hospital RWTH Aachen (UH-RWTH) between 2010-2021. Patients with missing radiological images, incomplete data on chemotherapy regimens, or prior splenectomy were excluded. Volumetric measurements of the spleen were performed on preoperative computerized tomography (CT) and magnetic resonance imaging (MRI) images, using segmentation software (3D-Slicer). Receiver-operating characteristic (ROC) analysis was performed to determine the optimal SH cut-off for predicting postoperative LSC. Independent risk factors of postoperative LSC were examined using logistic regression.

Results: A total of 115 patients were included in the study, of which 78 (68%) received oxaliplatin as part of their preoperative chemotherapy regimen. A threshold of 8.6% SH (Youden Index =0.25) was identified as predictive of postoperative LSC. Patients with SH >8.6% (n=62) received oxaliplatin significantly more often (84% vs. 49%; P<0.001) and exhibited higher rates of liver fibrosis (72% vs. 52%, P=0.03) and LSC (63% vs. 38%, P=0.007). Multivariable logistic regression analysis identified SH >8.6% as an independent risk factor for LSC (odds ratio 2.86, 95% confidence interval: 1.104-7.402, P=0.03).

Conclusions: Preoperative SH may be a valuable predictor of postoperative LSC in patients undergoing major liver resection for CRLM, following chemotherapy. Further studies are necessary to investigate the impact on a larger cohort and find preventive strategies to mitigate and treat CALI.

Keywords: Colorectal liver metastases (CRLM); chemotherapy; splenic hypertrophy (SH); surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-24-121/coif). D.T. reports honoraria from Bayer AG for lectures. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Volumetric measurement of the spleen using 3D-Slicer software on abdominal CT scans. (A) Axial, (B) 3D-model of the spleen, (C) coronal, (D) sagittal view. CT, computerized tomography.
Figure 2
Figure 2
Flowchart of inclusion and exclusion criteria, leading to the final study population. CRLM, colorectal liver metastases; CT, computerized tomography; MRI, magnetic resonance imaging.
Figure 3
Figure 3
ROC analysis of the whole cohort: splenic hypertrophy predicting postoperative liver specific complications. ROC, receiver-operating characteristic; AUC, area under the curve.
See this image and copyright information in PMC

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References

    1. Osterlund P, Salminen T, Soveri LM, et al. Repeated centralized multidisciplinary team assessment of resectability, clinical behavior, and outcomes in 1086 Finnish metastatic colorectal cancer patients (RAXO): A nationwide prospective intervention study. Lancet Reg Health Eur 2021;3:100049. 10.1016/j.lanepe.2021.100049 - DOI - PMC - PubMed
    1. Zorzi D, Laurent A, Pawlik TM, et al. Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg 2007;94:274-86. 10.1002/bjs.5719 - DOI - PubMed
    1. Sharma S, Camci C, Jabbour N. Management of hepatic metastasis from colorectal cancers: an update. J Hepatobiliary Pancreat Surg 2008;15:570-80. 10.1007/s00534-008-1350-x - DOI - PubMed
    1. Vauthey JN, Pawlik TM, Ribero D, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 2006;24:2065-72. 10.1200/JCO.2005.05.3074 - DOI - PubMed
    1. Lam VW, Spiro C, Laurence JM, et al. A systematic review of clinical response and survival outcomes of downsizing systemic chemotherapy and rescue liver surgery in patients with initially unresectable colorectal liver metastases. Ann Surg Oncol 2012;19:1292-301. 10.1245/s10434-011-2061-0 - DOI - PubMed

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