Background: Colorectal liver metastases (CRLM) occur in up to 50% of patients who suffer from colorectal cancer. While liver resection of CRLM remains the only curative treatment option, postoperative complications are common and mitigate the beneficial effects of CRLM resection on quality of life and survival in these patients. Liver fibrosis is a known risk factor for surgical morbidity and mortality after liver surgery. However, preoperative detection of liver fibrosis remains challenging. Noninvasive tests facilitate the diagnosis of liver fibrosis without the need for liver biopsies and histological grading. We thus analyzed the significance of noninvasive tests for liver fibrosis, including FIB-4 index and SAFE score, to predict adverse short-term outcome after CRLM resection.
Methods: A retrospective analysis of 107 patients who underwent surgery for CRLM at the Department for General, Visceral, Thoracic, and Transplantation Surgery of the University Hospital Giessen was performed to assess the correlation between suggested liver fibrosis as defined by noninvasive tests and short-term outcome.
Results: A high FIB-4 index or SAFE score, predictive of liver fibrosis, was associated with increased incidence and severity of postoperative complications. These results were validated and confirmed in an external, independent patient cohort of 277 patients who underwent liver resection owing to CRLM at the Department for General, Visceral, and Transplantation Surgery of the University Hospital Heidelberg.
Conclusion: Our findings provide a rationale for preoperative assessment of the FIB-4 index and SAFE score, as indicators of liver fibrosis, to identify CRLM patients at higher risk for postoperative complications.
Keywords: Colorectal liver metastases; Liver fibrosis; Liver resection; Non-invasive tests; Postoperative complications.
© 2026. The Author(s).