Neoadjuvant Oxaliplatin and Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: CT Features of Chemotherapy-Associated Liver Injury and Postoperative Complications.

RATIONALE AND

OBJECTIVES

Oxaliplatin-based neoadjuvant therapy (NAT) is increasingly being used in patients undergoing curative-intent surgery for pancreatic ductal adenocarcinoma (PDAC). Liver toxicity, notably through the development of chemotherapy-associated liver injury (CALI), has been shown in patients with colorectal liver metastases. However, its impact on postoperative complications after pancreaticoduodenectomy (PD) is not known. The study aimed to assess the hepatic changes on computed tomography (CT) imaging after oxaliplatin-based NAT and to identify markers predictive of postoperative complications.

MATERIALS AND

METHODS

CT scans were retrospectively analyzed before and after oxaliplatin-based NAT of consecutive patients undergoing PD for PDAC between 2017 and 2020. The appearance of qualitative and quantitative features of CALI, such as liver attenuation, liver surface nodularity, hepatic and splenic volumetry, liver enhancement patterns, and features of portal hypertension, were derived from CT images, and their association with postoperative complications were analyzed.

RESULTS

A total of 122 patients were analyzed (58 women; median age, 65 years [IQR,57-69]). Most patients received FOLFIRINOX protocol (n = 107, 87.7%). After chemotherapy, the splenic volume, heterogeneity of hepatic parenchymal enhancement, and portosystemic shunts significantly increased (p < 0.001). Preoperative low liver attenuation on unenhanced CT and heterogeneity of the liver parenchyma on contrast-enhanced CT were significantly associated with severe postoperative complications (p < 0.001). Liver attenuation value on unenhanced CT was inversely correlated with the Comprehensive Complication Index score (correlation coefficient -0.329, p < 0.001).

CONCLUSIONS

After oxaliplatin-based NAT for pancreatic ductal adenocarcinoma, imaging-based signs of CALI were associated with severe complications after pancreaticoduodenectomy.