QS112 - Splenic Enlargement After Neoadjuvant Chemotherapy Predicts Postoperative Complications After Curative Proctectomy for Rectal Cancer

Sunday, June 2, 2024

9:30 AM – 9:33 AM ET, USA

Location: Room 327

Quick Shot Presenter(s)

KENTARO OCHIAI, MD, PhD

Visiting Scientist
The University of Texas MD Anderson Cancer Center
The University of Texas MD Anderson Cancer Center
HOUSTON, TX, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

NS

Nir Stanietzky, MD

Associate Professor of Radioloy
MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
VS

Venkateswar Surabhi, n/a

Professor
MD Anderson Cancer Center
HOUSTON, Texas, United States

Disclosure information not submitted.
AI

Atsushi Ikeda, n/a

visiting scientist
MD Anderson Cancer Center
houston, Texas, United States

Disclosure information not submitted.
Abhineet Uppal, MD

Assistant Professor
University of Texas MD Anderson Cancer Center
University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
MW

Michael G. White, M.D., M.Sc.

Assistant Professor
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
OP

Oliver Peacock, BMBS PhD

Assistant Professor
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
Craig A. Messick, MD

Associate Professor of Surgery
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
BB

Brian Bednarski, MD

Associate Professor
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
Y. Nancy You, MD, MHSc

Professor
University of Texas MD Anderson Cancer Center
University of Texas MD Anderson Cancer Center
Houston, Texas, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
JS

John M. Skibber, MD

Professor
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

Disclosure information not submitted.
HK

Harmeet Kaur, n/a

Professor
MD Anderson Cancer Center
HOUSTON, Texas, United States

Disclosure information not submitted.
George J. Chang, MD, MS, MHCM (he/him/his)

Chair ad interim and Professor
The University of Texas MD Anderson Cancer Center
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no relevant relationships with ineligible companies.
Tsuyoshi Konishi, MD, PhD

Associate Professor
The University of Texas MD Anderson Cancer Center
The University of Texas MD Anderson Cancer Center
Houston, TX, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Purpose/Background: Neoadjuvant chemotherapy-induced hepatotoxicity and associated splenic enlargement are reportedly predictive of postoperative complications after hepatectomy for colorectal liver metastasis. However, its impact on primary rectal cancer surgery remains unknown. This study aims to investigate the association between neoadjuvant chemotherapy-induced splenic enlargement and postoperative complications after curative proctectomy for rectal cancer.

Methods/Interventions: A prospectively maintained institutional database was queried for consecutive patients who underwent curative proctectomy for non-metastatic rectal cancer after neoadjuvant chemotherapy with or without radiotherapy during January 2016 and December 2021. Clinicopathologic parameters were collected from the institutional database with retrospective chart review. Splenic size and diameters of the splenic vein and portal vein were assessed in computed tomography before and after neoadjuvant chemotherapy. Splenic volume was calculated using a splenic index (Splenic volume = 30 + 0.58 ×maximal splenic length ×width ×thickness).

Results/Outcomes: A total of 292 patients were included in the study. A median splenic volume was 280ml in baseline and 337ml after neoadjuvant chemotherapy (p < 0.0001). Increased splenic volume after chemotherapy was observed in 233 patients (79.8 %). A median increase of splenic volume was 16% (IQR, 3-34%), whereas the size of the portal vein and splenic vein were not significantly changed after neoadjuvant chemotherapy (a median increase of -1% and 2%, respectively). The ROC curve showed a splenic volume increase of 62% as a cut-off value for predicting postoperative major complications. Patients with >62% increase in splenic volume (N=29, 9.9 %) had significantly lower preoperative platelet count (median 136K/μL vs. 197K/μL, p< 0.0001) and significantly higher rates of overall postoperative complications (55.2% vs. 32.7%, p=0.02), major complications (20.7% vs. 5.7%, p=0.003), infectious complications (24.1% vs. 10.7%, p=0.033) and anastomotic leakage/pelvic abscess (20.8% vs. 7.3%, p=0.03) (Table 1). Clinical backgrounds, tumor stage, intraoperative blood loss and other perioperative outcomes were not different with and without splenic enlargement.

Conclusion/Discussion: Splenic enlargement after neoadjuvant chemotherapy was predictive of postoperative complications after curative proctectomy for rectal cancer. Patients with >62% splenic enlargement after neoadjuvant chemotherapy need careful perioperative management and active preventive interventions.