Journal Article

Perioperative complications influence recurrence and survival after resection of hepatic colorectal metastases

Fischer, M., Fong, Y., Grant, F., Gonen, M., Kingham, T. P., Jarnagin, W. R., Correa-Gallego, C., Allen, P. J., D’Angelica, M. I., Arslan-Carlon, V., DeMatteo, R. P., Kemeny, N. E.

2013

Overview

Background Perioperative outcomes, such as blood loss, transfusions, and morbidity, have been linked to cancer-specific survival, but this is largely unsupported by prospective data. Methods Patients from a previous, randomized trial that evaluated acute normovolemic hemodilution during major hepatectomy (≥3 segments) were reevaluated and those with metastatic colorectal cancer ( n  = 90) were selected for analysis. Survival data were obtained from the medical record. Disease extent was measured using a clinical-risk score (CRS). Log-rank test and Cox proportional hazard model were used to evaluate recurrence-free survival (RFS) and overall survival (OS). Results Median follow-up was 71 months. The CRS was ≥3 in 45 % of patients; 59 % had extrahepatic procedures. Morbidity and mortality were 33 and 2 %, respectively. Postoperative chemotherapy was given to 87 % of patients (78/90) starting at a median of 6 weeks. RFS and OS were 29 and 60 months, respectively. Postoperative morbidity significantly reduced RFS (23 vs. 69 months; P  < 0.001) and OS (28 vs. 74 months; P  < 0.001) on uni- and multi-variate analysis; positive resection margins and high CRS also were significant factors. Delayed initiation of postoperative chemotherapy (≥8 weeks) was common in patients with complications (37 vs. 12 %; P  = 0.01). Conclusions In this selected cohort of patients from a previous RCT, perioperative morbidity was strongly (and independently) associated with cancer-specific outcome. It also was associated with delayed initiation of postoperative chemotherapy, the impact of which on survival is unclear.

• Publisher: Springer US,Springer Nature B.V
• Subject: Abdominal Abscess - etiology / Blood Loss, Surgical / Chemotherapy, Adjuvant / Colorectal Neoplasms - pathology / Disease-Free Survival / Equipment Failure / Female / Hemodilution / Hepatectomy - adverse effects / Hepatobiliary Tumors / Hospital Mortality / Humans / Ileus - etiology / Infusion Pumps, Implantable - adverse effects / Length of Stay / Liver Neoplasms - drug therapy / Liver Neoplasms - secondary / Liver Neoplasms - surgery / Male / Medicine / Medicine & Public Health / Middle Aged / Multivariate Analysis / Myocardial Ischemia - etiology / Neoplasm, Residual / Oncology / Recurrence / Risk Assessment / Surgery / Surgical Oncology / Surgical Wound Infection - etiology / Survival Rate / Tachycardia - etiology / Time Factors / Transfusion Reaction / Venous Thrombosis - etiology