Splenic hypertrophy predicts liver-specific complications in patients undergoing major liver resection for colorectal liver metastases, after preoperative chemotherapy

Background: In patients with colorectal liver metastases (CRLM), preoperative chemotherapy may increase resectability and survival outcomes. However, cytotoxic agents can also cause chemotherapyassociated liver injury (CALI), leading to increased rates of postoperative complications. This study evaluates the association between splenic hypertrophy (SH) after preoperative chemotherapy and postoperative liverspecific 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 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.