Oxaliplatin-induced spleen hypertrophy as a predictor of liver-specific complications following curative resection of colorectal liver metastases

Background In patients with colorectal liver metastases (CRLM), preoperative oxaliplatin-based chemotherapy may cause sinusoidal obstruction syndrome, leading to portal hypertension and splenomegaly, which can be used as an indicator of liver injury. This study evaluates the association between splenic hypertrophy after preoperative chemotherapy and postoperative liver-specific complications, in patients undergoing major liver resection for CRLM.

Methods This retrospective study included patients with CRLM, who underwent major curative liver resection following chemotherapy between 2010-2021, at the University Hospital RWTH Aachen. Patients with missing radiological images, incomplete data on chemotherapy regimens, or prior splenectomy were excluded. Volumetric measurements of the spleen were performed on preoperative, pre- and post-chemotherapy CT and MRT images, using segmentation software (3D-Slicer). Receiver-operating characteristic analysis was performed to determine the optimal spleen hypertrophy cut-off for predicting postoperative liver-specific complications. These were defined as: biliary complications, haemobilia, posthepatectomy liver failure, hepatorenal syndrome, postoperative hamorrhage due to inadequate coagulation factor synthesis, and portal-hypertension-related complications, such as ascites. Independent risk factors regarding postoperative liver specific complications were examined using logistic regression.

Results Of 115 patients included in the study, 78 (68%) received oxaliplatin. A threshold of 8.6% splenic hypertrophy (Youden Index=0.25) was identified as a predictor of liver-specific complications (area under the curve 0.623; p=0.022). Patients above the cut-off (n=62) were administered oxaliplatin significantly more often (84% vs. 49%; p<0.001), than those below (n=53). Rates of liver fibrosis (58% vs. 42%, p=0.029) and liver-specific complications (63% vs. 38%, p=0.007) were also higher in the group above the cut-off. Multivariable logistic regression analysis for liver-specific complications, showed an odds ratio of 2.86 (p=0.03) for splenic hypertrophy above 8.6%.

Conclusion Preoperative splenic volumetry may be a valuable predictor of postoperative liver-specific complications in patients undergoing CRLM resection after chemotherapy. Further studies are necessary to investigate the impact on a larger cohort and find preventive strategies to mitigate and treat chemotherapy-induced hepatic injury.

Publication History

Article published online:
28 August 2023