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


Authors: Simpson, A. L.; Leal, J. N.; Pugalenthi, A.; Allen, P. J.; DeMatteo, R. P.; Fong, Y.; Gonen, M.; Jarnagin, W. R.; Kingham, T. P.; Miga, M. I.; Shia, J.; Weiser, M. R.; D'Angelica, M. I.
Article Title: 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.
Journal Title: Journal of the American College of Surgeons
Volume: 220
Issue: 3
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2015-03-01
Start Page: 271
End Page: 280
Language: English
DOI: 10.1016/j.jamcollsurg.2014.12.008
PROVIDER: scopus
PUBMED: 25617913
PMCID: PMC4411084
DOI/URL:
Notes: Abstract presented at the American College of Surgeons 100th Annual Clinical Congress; 2014 Oct 26-30; San Francisco, CA -- Export Date: 2 March 2015 -- Source: Scopus
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MSK Authors
  1. Ronald P DeMatteo
    605 DeMatteo
  2. Mithat Gonen
    721 Gonen
  3. Jinru Shia
    466 Shia
  4. Martin R Weiser
    346 Weiser
  5. Peter Allen
    445 Allen
  6. William R Jarnagin
    598 Jarnagin
  7. Yuman Fong
    746 Fong
  8. T Peter Kingham
    295 Kingham
  9. Amber L Simpson
    52 Simpson
  10. Julie Leal
    12 Leal