Amber L Simpson1, Julie N Leal2, Amudhan Pugalenthi2, Peter J Allen2, Ronald P DeMatteo2, Yuman Fong2, Mithat Gönen3, William R Jarnagin2, T Peter Kingham2, Michael I Miga4, Jinru Shia5, Martin R Weiser2, Michael I D'Angelica6. 1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN. 2. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. 3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY. 4. Department of Biomedical Engineering, Vanderbilt University, Nashville, TN. 5. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY. 6. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: dangelim@mskcc.org.
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 (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.
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, CRCLMpatients 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.
Authors: Amber L Simpson; David A Geller; Alan W Hemming; William R Jarnagin; Logan W Clements; Michael I D'Angelica; Prashanth Dumpuri; Mithat Gönen; Ivan Zendejas; Michael I Miga; James D Stefansic Journal: J Am Coll Surg Date: 2014-03-27 Impact factor: 6.113
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Authors: Patrick S Wolf; James O Park; Fei Bao; Peter J Allen; Ronald P DeMatteo; Yuman Fong; William R Jarnagin; T Peter Kingham; Mithat Gönen; Nancy Kemeny; Jinru Shia; Michael I D'Angelica Journal: J Am Coll Surg Date: 2012-10-05 Impact factor: 6.113
Authors: Julie N Leal; T Peter Kingham; Michael I D'Angelica; Ronald P DeMatteo; William R Jarnagin; Marcia F Kalin; Peter J Allen Journal: J Gastrointest Surg Date: 2015-07-10 Impact factor: 3.452
Authors: Gabriel E Humpire-Mamani; Joris Bukala; Ernst T Scholten; Mathias Prokop; Bram van Ginneken; Colin Jacobs Journal: Radiol Artif Intell Date: 2020-07-22