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

Introduction In patients with colorectal liver metastases (CRLM), preoperative chemotherapy may cause sinusoidal obstruction syndrome, portal hypertension, and splenomegaly. This study evaluates the association between splenic hypertrophy and postoperative complications, after major resection for CRLM.

Method This retrospective study included patients with CRLM, who underwent major curative liver resection following chemotherapy between 2010-2021. 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 included biliary complications, haemobilia, post-hepatectomy liver failure, hepatorenal syndrome, postoperative hemorrhage due to inadequate coagulation factor synthesis, and portal-hypertension-related complications, such as ascites. 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 (AUC 0.623; p=0.022). Patients above the cut-off (n=62) were administered oxaliplatin significantly more often (84% vs. 49%; p<0.001). Rates of liver fibrosis (58% vs. 42%, p=0.029) and liver-specific complications (63% vs. 38%, p=0.007) were also higher in that group. Multivariable logistic regression analysis for liver-specific complications, showed an odds ratio of 2.86 (95%CI 1.104-7.402, 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.

Publication History

Article published online:
23 January 2024