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(CAL...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.展开更多
基金supported by the START-Program(#01/23)of the Faculty of Medicine of the RWTH Aachen University,Aachen,Germany。
文摘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.
