Is there a role for simultaneous hepatic and colorectal resections? A contemporary view from NSQIP.
Abstract
INTRODUCTION: The optimal timing of primary and metastatic tumor management in patients
with synchronous hepatic colorectal metastases remains controversial. We aimed to
compare perioperative outcomes of simultaneous colorectal/liver resection (SCLR) with
isolated resections utilizing a national clinical database. METHODS: NSQIP data from
2005 to 2009 were examined to construct risk-adjusted generalized linear models and
to calculate group-specific predicted estimates. These were used to compare 30-day
perioperative outcomes among patients undergoing SCLR with colorectal (CR) and liver
resections (LR) only in patients with metastatic colorectal cancer. RESULTS: A total
of 3,983 patients were identified, who underwent SCLR (192), LR (1,857), or CR (1,934).
Rectal resection was performed in 45 (23.4 %) SCLR patients and 269 (13.9 %) CR patients
(p < 0.001). Major hepatectomy was performed in 69 (35.9 %) SCLR patients and 774
(41.7 %) LR patients (p = 0.12). Median adjusted operation time (SCLR: 273 min, 95
% CI: 253-295; CR: 172, CI: 168-177; LR: 222, CI: 217-228; p < 0.001) and median adjusted
length of hospital stay (SCLR: 9.5 days, CI: 8.8-10.4; CR: 8.1, CI: 7.9-8.3; LR: 6.4,
CI: 6.3-6.6; p < 0.001) were longer for SCLR compared to CR and LR. Adjusted predicted
risks for at least one postoperative complication were higher in SCLR (36.3 %) than
in CR (26.6 %) and LR (19.8 %) (p < 0.003), mostly due to infectious/cardiopulmonary
issues. DISCUSSION: In SCLR patients, the risk of 30-day adverse outcomes is higher,
and median operation time as well as length of hospital stay is longer compared to
CR and LR patients. However, the expected combined morbidities of staged procedures
though likely favor SCLR in carefully selected patients undergoing even complex hepatic
and colorectal resections and should be considered.
Type
Journal articleSubject
AgedColectomy
Colorectal Neoplasms
Female
Hepatectomy
Humans
Length of Stay
Liver Neoplasms
Male
Middle Aged
Postoperative Complications
Quality Improvement
Treatment Outcome
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https://hdl.handle.net/10161/14849Published Version (Please cite this version)
10.1007/s11605-012-1990-7Publication Info
Worni, Mathias; Mantyh, Christopher R; Akushevich, Igor; Pietrobon, Ricardo; & Clary,
Bryan M (2012). Is there a role for simultaneous hepatic and colorectal resections? A contemporary
view from NSQIP. J Gastrointest Surg, 16(11). pp. 2074-2085. 10.1007/s11605-012-1990-7. Retrieved from https://hdl.handle.net/10161/14849.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Igor Akushevich
Research Professor in the Social Science Research Institute
Christopher Ritchie Mantyh
Professor of Surgery
Neurogenic inflammation Ulcerative colitis Crohn's disease Neuropeptides Receptors
Vanilloid receptor Substance P Intestinal motility Colorectal cancer outcomes Colon
cancer Rectal cancer
Mathias Worni
Medical Instructor in the Department of Surgery
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