Preoperative three-dimensional lung volumetry: a novel method for prediction of respiratory complications in patients undergoing major liver resection for colorectal metastases

Abstract Patients undergoing major liver resection often suffer from significant perioperative morbidity. This study examines the ability of lung volumetry, based on preoperative computerized tomography (CT), to predict postoperative pulmonary complications after major liver resection for colorectal liver metastases (CRLM). Patients undergoing major liver resection for CRLM between 2010–2021 with suitable chest CT, were included. Preoperative total lung volume (TLV) was measured using 3D-Slicer version 4.11.20210226 (http://www.slicer.org). Receiver-operating characteristic (ROC) and area under the curve (AUC) analyses were used to define a cut-off, for prediction of postoperative respiratory complications. Differences between groups were examined with Chi-square and Mann-Whitney U tests. Risk factors for the development of respiratory complications were identified through logistic regression. Of 123 patients included, 35 (29%) developed respiratory complications. A good predictive ability of TLV was shown (AUC 0.62, p = 0.036), with an ideal cut-off value of 4500cm3. Patients with TLV < 4500cm3 suffered from significantly higher rates of respiratory complications (44% vs. 21%, p = 0.007), and TLV < 4500cm3 was an independent risk factor (odds ratio 3.777, 95% confidence intervals 1.488–9.588, p = 0.005). Preoperative TLV is a viable predictor of postoperative pulmonary complications in patients undergoing major liver resection for CRLM. More studies in larger cohorts are necessary to further evaluate this technique.