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Abstract：
Colorectal liver metastases (CRLM) are the predominant factor limiting survival in patients with colorectal cancer and liver resection with complete tumor removal is the best treatment option for these patients. This study examines the predictive ability of three-dimensional lung volumetry (3DLV) based on preoperative computerized tomography (CT), to predict postoperative pulmonary complications in patients undergoing major liver resection for CRLM. Patients undergoing major curative liver resection for CRLM between 2010 and 2021 with a preoperative CT scan of the thorax within 6 weeks of surgery, were included. Total lung volume (TLV) was calculated using volumetry software 3D-Slicer version 4.11.20210226 including Chest Imaging Platform extension ( http://www.slicer.org ). The area under the curve (AUC) of a receiver-operating characteristic analysis was used to define a cut-off value of TLV, for predicting the occurrence of postoperative respiratory complications. Differences between patients with TLV below and above the cut-off were examined with Chi-square or Fisher\'s exact test and Mann-Whitney U tests and logistic regression was used to determine independent risk factors for the development of respiratory complications. A total of 123 patients were included, of which 35 (29%) developed respiratory complications. A predictive ability of TLV regarding respiratory complications was shown (AUC 0.62, p = 0.036) and a cut-off value of 4500 cm3 was defined. Patients with TLV < 4500 cm3 were shown to suffer from significantly higher rates of respiratory complications (44% vs. 21%, p = 0.007) compared to the rest. Logistic regression analysis identified TLV < 4500 cm3 as an independent predictor for the occurrence of respiratory complications (odds ratio 3.777, 95% confidence intervals 1.488-9.588, p = 0.005). Preoperative 3DLV is a viable technique for prediction of postoperative pulmonary complications in patients undergoing major liver resection for CRLM. More studies in larger cohorts are necessary to further evaluate this technique.
摘要：
结直肠癌肝转移（CRLM）是限制结直肠癌患者生存的主要因素，完全切除肿瘤的肝切除术是这些患者的最佳治疗选择。这项研究检查了基于术前计算机断层扫描（CT）的三维肺容积（3DLV）的预测能力，预测接受CRLM肝脏大切除术的患者术后肺部并发症。在2010年至2021年期间接受CRLM的主要根治性肝切除术的患者，在手术后6周内进行胸部的术前CT扫描，包括在内。使用容量测量软件3D-Slicer版本4.11.20210226计算总肺容积(TLV),包括胸部成像平台扩展(http://www.slicer.org)。受试者工作特性分析的曲线下面积（AUC）用于定义TLV的截止值，用于预测术后呼吸系统并发症的发生。使用卡方或Fisher精确检验和Mann-WhitneyU检验检查TLV低于和高于截止值的患者之间的差异，并使用logistic回归来确定发生呼吸系统并发症的独立危险因素。共纳入123例患者，其中35人（29%）出现呼吸道并发症。显示了TLV对呼吸系统并发症的预测能力（AUC0.62，p=0.036），并定义了4500cm3的临界值。TLV<4500cm3的患者患呼吸系统并发症的比率明显较高（44%vs.21%,p=0.007）与其余部分相比。Logistic回归分析确定TLV<4500cm3是呼吸系统并发症发生的独立预测因子（比值比3.777，95％置信区间1.488-9.588，p=0.005）。术前3DLV是预测接受CRLM的主要肝切除术患者术后肺部并发症的可行技术。需要在更大的队列中进行更多的研究来进一步评估这种技术。
