Chemotherapy-induced splenic volume increase is independently associated with major complications after hepatic resection for metastatic colorectal cancer.

Simpson AL, Leal JN, Pugalenthi A, Allen PJ, DeMatteo RP, Fong Y, Gönen M, Jarnagin WR, Kingham TP, Miga MI, Shia J, Weiser MR, D'Angelica MI
J Am Coll Surg. 2015 220 (3): 271-80

PMID: 25617913 · PMCID: PMC4411084 · DOI:10.1016/j.jamcollsurg.2014.12.008

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 (R(2) = 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.

Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

MeSH Terms (22)

Adult Aged Aged, 80 and over Antineoplastic Agents Antineoplastic Combined Chemotherapy Protocols Case-Control Studies Chemotherapy, Adjuvant Colorectal Neoplasms Female Follow-Up Studies Hepatectomy Humans Liver Neoplasms Male Middle Aged Neoadjuvant Therapy Postoperative Complications Retrospective Studies Risk Factors Single-Blind Method Splenomegaly Treatment Outcome

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