Evaluating liver toxicity from oxaliplatin-based neoadjuvant therapy (NAT) can enhance surgical decision-making for pancreatic ductal adenocarcinoma.

• Significant increases in splenic volume and hepatic parenchyma variability were observed post-chemotherapy (p < 0.001).
• Low liver attenuation and heterogeneous enhancement pre-surgery were linked to severe postoperative complications (p < 0.001).

This study underscores the importance of preoperative imaging in assessing risk for complications after pancreaticoduodenectomy.

• An inverse correlation exists between liver attenuation and complication index scores (r = -0.329, p < 0.001).