Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2018; 10(2): 21-27
Published online Feb 27, 2018. doi: 10.4240/wjgs.v10.i2.21
Perioperative liver and spleen elastography in patients without chronic liver disease
Sam Eriksson, Hanna Borsiin, Carl-Fredrik Öberg, Hannes Brange, Zoran Mijovic, Christian Sturesson
Sam Eriksson, Hanna Borsiin, Carl-Fredrik Öberg, Hannes Brange, Christian Sturesson, Department of Surgery, Lund University, Skåne University Hospital, Lund S-221 85, Sweden
Zoran Mijovic, Department of Radiology, Lund University, Skåne University Hospital, Lund S-221 85, Sweden
Author contributions: Eriksson S contributed with methodology, data analysis, data presentation and writing of an original draft of the manuscript; Borsiin H, Öberg CF and Brange H contributed with project administration, data acquisition and data analysis; Mijovic Z contributed with methodology; Sturesson C contributed with conceptualization, methodology and supervision; all authors conducted critical revisions and approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Regional Ethical Review Board Lund.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have declared that no competing interests exist.
Data sharing statement: No additional data are available for sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Christian Sturesson, MD, PhD, Associate Professor, Surgeon, Department of Surgery, Lund University, Skåne University Hospital, Lund S-221 85, Sweden. christian.sturesson@med.lu.se
Telephone: +46-46-172347 Fax: +46-46-172335
Received: November 2, 2017
Peer-review started: November 2, 2017
First decision: December 6, 2017
Revised: January 14, 2018
Accepted: February 6, 2018
Article in press: February 6, 2018
Published online: February 27, 2018

To investigate changes in hepatic and splenic stiffness in patients without chronic liver disease during liver resection for hepatic tumors.


Patients scheduled for liver resection for hepatic tumors were considered for enrollment. Tissue stiffness measurements on liver and spleen were conducted before and two days after liver resection using point shear-wave elastography. Histological analysis of the resected liver specimen was conducted in all patients and patients with marked liver fibrosis were excluded from further study analysis. Patients were divided into groups depending on size of resection and whether they had received preoperative chemotherapy or not. The relation between tissue stiffness and postoperative biochemistry was investigated.


Results are presented as median (interquartile range). 35 patients were included. The liver stiffness increased in patients undergoing a major resection from 1.41 (1.24-1.63) m/s to 2.20 (1.72-2.44) m/s (P = 0.001). No change in liver stiffness in patients undergoing a minor resection was found [1.31 (1.15-1.52) m/s vs 1.37 (1.12-1.77) m/s, P = 0.438]. A major resection resulted in a 16% (7%-33%) increase in spleen stiffness, more (P = 0.047) than after a minor resection [2 (-1-13) %]. Patients who underwent preoperative chemotherapy (n = 20) did not differ from others in preoperative right liver lobe [1.31 (1.16-1.50) vs 1.38 (1.12-1.56) m/s, P = 0.569] or spleen [2.79 (2.33-3.11) vs 2.71 (2.37-2.86) m/s, P = 0.515] stiffness. Remnant liver stiffness on the second postoperative day did not show strong correlations with maximum postoperative increase in bilirubin (R2 = 0.154, Pearson’s r = 0.392, P = 0.032) and international normalized ratio (R2 = 0.285, Pearson’s r = 0.534, P = 0.003).


Liver and spleen stiffness increase after a major liver resection for hepatic tumors in patients without chronic liver disease.

Keywords: Chemotherapy, Adjuvant, Colorectal neoplasms, Elasticity imaging techniques, Hepatectomy, Liver neoplasms

Core tip: Point shear-wave elastography is an ultrasound-based technique which lets the user measure tissue stiffness. The technique has previously mostly been used to study patients with chronic liver disease and cirrhosis. In the current study we investigate changes in liver and spleen stiffness in patients without chronic liver disease undergoing chemotherapy and liver resection for liver tumors. A major liver resection resulted in a 42% increase in liver stiffness. Also, spleen stiffness increased more after a major than after a minor resection. However, there was no difference in tissue stiffness between patients who received preoperative chemotherapy or not.