Chemotherapy-Induced Splenic Volume Increase Is Independently Associated with Major Complications after Hepatic Resection for Metastatic Colorectal Cancer

Abstract

BACKGROUND In patients with colorectal cancer liver metastases (CRCLM), chemotherapy-induced hepatic injury is associated with increased splenic volume, thrombocytopenia, and decreased long-term survival. The current study investigates the relationship between change in splenic volume after preoperative chemotherapy and development of postoperative complications. STUDY DESIGN The study group consisted of 80 patients who underwent resection of CRCLM; half received neoadjuvant chemotherapy for 6 months before resection (n = 40) and the other half did not (n = 40). The study group was compared with two control groups: a normal group composed of patients undergoing cholecystectomy for benign disease (n = 40) and a group of untreated, nonmetastatic colorectal cancer (CRC) patients (n = 40). Splenic volume was measured by CT/MRI volumetry. In the study group, the nontumoral liver was graded for steatosis and sinusoidal injury; operative and outcomes characteristics were also analyzed. RESULTS Before chemotherapy, CRCLM patients had normalized spleen volumes of 3.2 ± 1.1 mL/kg, significantly higher than normal (2.5 ± 0.8 mL/kg; p < 0.001) and nonmetastatic CRC (2.6 ± 1.3 mL/kg; p < 0.05) patients, with higher splenic volume after 6 months of chemotherapy (4.2 ± 1.7 mL/kg; p < 0.01). After chemotherapy, splenic volume increase was associated with any perioperative complication (p < 0.01) and major complications (p < 0.05). Patients with ≥39% splenic volume increase (maximal chi-square test) were significantly more likely to have major complications (p < 0.01). Spleen volume changes were not correlated with change in platelet count (R2 = 0.03; p = 0.301). CONCLUSIONS In patients with CRCLM, the presence of liver metastases and chemotherapy are associated with higher splenic volume. Percent splenic volume increase after 6 months of chemotherapy can aid preoperative risk stratification, as it was an independent predictor of major postoperative complications.

Intraductal Papillary Mucinous Neoplasms and the Risk of Diabetes Mellitus in Patients Undergoing Resection Versus Observation

“…The software was designed for liver segmentation prior to surgery; however, any anatomic area of interest that is distinguishable on CT scan can be segmented and volume calculated. 18 In the current study, both the pancreas and cyst were segmented manually and volumes were obtained at diagnosis and either postoperatively (resected group) or at 12-month follow-up (observed group). In the observed group, pancreatic volume at diagnosis and at 12-month follow-up was calculated as absolute pancreas volume minus pancreatic cyst volume.…”

Weighted gene co-expression network analysis of colorectal cancer liver metastasis genome sequencing data and screening of anti-metastasis drugs

“…Secondly, chemoradiation can cause serious damage to normal tissue such as bone marrow suppression and compromises the patient's overall health (6,7). Thirdly, adjuvant chemo-radiation therapy may directly lead to liver injury and increase complications after liver resection (8,9). In recent years, molecular-targeted therapy has emerged as an effective strategy for the treatment of metastatic cancer (10).…”

Assessing splenic enlargement on CT by unidimensional measurement changes in patients with colorectal liver metastases

“…Most of the variation in Δ W and Δ H is explained by volume change as evidenced by modest improvement in R 2 when weight is factored into the regression. These linear equations show that a change of >0.9 cm in width or height predicts a splenic volumetric enlargement of approximately 39%, which has been associated with major complications [13]. …”

“…First, an upper limit of 314.5 mL for splenic volume was defined as normal [7, 8, 11]. Second, an increase of >39% from baseline measure was determined to be associated with major complications and, therefore, clinically relevant [13]. …”

“…A method to assess splenic enlargement that is both accurate and practical would be helpful for patients with CRC liver metastases as those who develop splenomegaly as a result of chemotherapy are at risk for complications [13]. Although the radiological studies cited above have emphasized accuracy of splenic volumetry to evaluate for splenomegaly, the existing methods are cumbersome in clinical practice [7, 8, 11, 12].…”