1. Porto-sinusoidal vascular disorder in surgical candidates for liver metastases: Prevalence, noninvasive diagnosis, and burden on surgical outcomes.
- Author
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Dajti E, Serenari M, Malvi D, Dajti G, Ravaioli F, Colecchia L, Marasco G, Caputo F, Renzulli M, Vasuri F, Vestito A, Azzaroli F, Barbara G, Ravaioli M, Festi D, D'Errico A, Cescon M, and Colecchia A
- Subjects
- Humans, Male, Female, Middle Aged, Prospective Studies, Prevalence, Aged, Spleen pathology, Spleen surgery, Liver surgery, Liver pathology, Liver diagnostic imaging, Treatment Outcome, Liver Failure etiology, Liver Failure epidemiology, Liver Failure diagnosis, Risk Factors, Predictive Value of Tests, Adult, Liver Neoplasms surgery, Liver Neoplasms secondary, Hepatectomy adverse effects, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications diagnosis, Elasticity Imaging Techniques statistics & numerical data, Elasticity Imaging Techniques methods
- Abstract
Chemotherapy can cause vascular and metabolic liver injury in patients with liver metastases, but scarce data are available. We aimed to (i) describe the prevalence of porto-sinusoidal vascular disorder (PSVD) among patients undergoing resection for liver metastases; and (ii) assess whether liver (LSM) and spleen stiffness measurements could diagnose PSVD and predict postoperative complications. This is a prospective single-center study enrolling consecutive patients undergoing hepatic resection for metastases at a tertiary center. For each patient, we evaluated previous exposure to chemotherapy, comorbidities, elastography, type of surgery, histological features at the resection specimen, morbidity (post-hepatectomy liver failure and major complications according to Clavien-Dindo), and 90-day survival. Sixty-eight patients were included, of whom 60 (88%) had received chemotherapy. Twenty-nine (44%) patients had PSVD. Spleen stiffness measurements <21 kPa (negative predictive value 87%) and >40 kPa (positive predictive value 100%) could accurately diagnose PSVD. PSVD significantly increased the risk of post-hepatectomy liver failure (22% vs. 45%) and major complications (11% vs. 31%). Preoperative LSM was associated with postoperative morbidity. The cutoff LSMs <4.5 and >8 kPa predicted the risk of clinically significant post-hepatectomy liver failure (0%, 11%, and 33% in LSM <4.5, 4.5-8, and >8 kPa, respectively) and major complications (0%, 25%, 44% in LSM <4.5, 4.5-8, and >8 kPa, respectively). PSVD is very common among patients undergoing liver surgery for metastases, and it is associated with increased morbidity. LSM and spleen stiffness measurements can correctly identify patients with PSVD and those at risk of clinically relevant postoperative complications., (Copyright © 2024 American Association for the Study of Liver Diseases.)
- Published
- 2025
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