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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2013

01-08-2013 | Hepatobiliary Tumors

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

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

Published in: Annals of Surgical Oncology | Issue 8/2013

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Abstract

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.
Literature
1.
Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–18; discussion 318–21.PubMedCrossRef
2.
Blumberg N, Heal JM. Transfusion-induced immunomodulation and its possible role in cancer recurrence and perioperative bacterial infection. Yale J Biol Med. 1990;63:429–33.PubMed
3.
Stephenson KR, Steinberg SM, Hughes KS, et al. Perioperative blood transfusions are associated with decreased time to recurrence and decreased survival after resection of colorectal liver metastases. Ann Surg. 1988;208:679–87.PubMedCrossRef
4.
Giuliante F, Ardito F, Vellone M, et al. Role of the surgeon as a variable in long-term survival after liver resection for colorectal metastases. J Surg Oncol. 2009;100:538–45.PubMedCrossRef
5.
Vigano L, Ferrero A, Lo Tesoriere R, et al. Liver surgery for colorectal metastases: results after 10 years of follow-up. Long-term survivors, late recurrences, and prognostic role of morbidity. Ann Surg Oncol. 2008;15:2458–64.PubMedCrossRef
6.
Cunningham JD, Fong Y, Shriver C, et al. One hundred consecutive hepatic resections. Blood loss, transfusion, and operative technique. Arch Surg. 1994;129:1050–6.PubMedCrossRef
7.
Melendez J. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg. 1998;187:620–5.PubMedCrossRef
8.
Jarnagin WR, Gonen M, Maithel SK, et al. A prospective randomized trial of acute normovolemic hemodilution compared to standard intraoperative management in patients undergoing major hepatic resection. Ann Surg. 2008;248:360–9.PubMed
9.
House MG, Ito H, Gonen M, et al. Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1,600 patients during two decades at a single institution. J Am Coll Surg. 2010;210:744-52, 752–5.
10.
Grobmyer SR, Pieracci FM, Allen PJ, et al. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg. 2007;204:356–64.PubMedCrossRef
11.
Farid SG, Aldouri A, Morris-Stiff G, et al. Correlation between postoperative infective complications and long-term outcomes after hepatic resection for colorectal liver metastasis. Ann Surg. 2010;251:91–100.PubMedCrossRef
12.
Ito H, Are C, Gonen M, et al. Effect of postoperative morbidity on long-term survival after hepatic resection for metastatic colorectal cancer. Ann Surg. 2008;247:994–1002.PubMedCrossRef
13.
Chauhan A, House MG, Pitt HA, et al. Post-operative morbidity results in decreased long-term survival after resection for hilar cholangiocarcinoma. HPB (Oxford). 2011;13:139–47.CrossRef
14.
Schiesser M, Chen JW, Maddern GJ, et al. Perioperative morbidity affects long-term survival in patients following liver resection for colorectal metastases. J Gastrointest Surg. 2008;12:1054–60.PubMedCrossRef
15.
Tanaka K, Kumamoto T, Nojiri K, et al. Impact of postoperative morbidity on long-term survival after resection for colorectal liver metastases. Ann Surg Oncol. 2010. doi:10.​1245/​s10434-010-1352-1
16.
Kooby DA, Stockman J, Ben-Porat L, et al. Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg. 2003;237:860–9; discussion 869–70.PubMed
17.
Mavros MN, de Jong M, Dogeas E, et al. Impact of complications on long-term survival after resection of colorectal liver metastases. Br J Surg. 2013;100(5):711–8.PubMedCrossRef
18.
Kobayashi T, Teruya M, Kishiki T, et al. Elevated C-reactive protein and hypoalbuminemia measured before resection of colorectal liver metastases predict postoperative survival. Dig Surg. 2010;27:285–90.PubMedCrossRef
19.
Wong VK, Malik HZ, Hamady ZZ, et al. C-reactive protein as a predictor of prognosis following curative resection for colorectal liver metastases. Br J Cancer. 2007;96:222–5.PubMedCrossRef
20.
Martinez-Salamanca JI, Shariat SF, Rodriguez JC, et al. Prognostic role of ECOG performance status in patients with urothelial carcinoma of the upper urinary tract: an international study. BJU Int. 2011;109(8):1155–61.PubMedCrossRef
21.
Wedding U, Rohrig B, Klippstein A, et al. Age, severe comorbidity and functional impairment independently contribute to poor survival in cancer patients. J Cancer Res Clin Oncol. 2007;133:945–50.PubMedCrossRef
22.
Foster JH, Berman MM: Solid liver tumors. Major Probl Clin Surg. 1977;22:1–342.PubMed
23.
Virani S, Michaelson JS, Hutter MM, et al. Morbidity and mortality after liver resection: results of the patient safety in surgery study. J Am Coll Surg. 2007;204:1284–92.PubMedCrossRef
24.
Kamiyama T, Nakanishi K, Yokoo H, et al. Perioperative management of hepatic resection toward zero mortality and morbidity: analysis of 793 consecutive cases in a single institution. J Am Coll Surg. 2010;211:443–9.PubMedCrossRef
25.
Fan ST, Mau Lo C, Poon RT, et al. Continuous improvement of survival outcomes of resection of hepatocellular carcinoma: a 20-year experience. Ann Surg. 2011;253:745–58.PubMedCrossRef
26.
Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236:397–406; discussion 406–7.PubMedCrossRef
Metadata
Title
Perioperative complications influence recurrence and survival after resection of hepatic colorectal metastases
Authors
C. Correa-Gallego, MD
M. Gonen, PhD
M. Fischer, MD
F. Grant, MD
N. E. Kemeny, MD
V. Arslan-Carlon, MD
T. P. Kingham, MD
R. P. DeMatteo, MD
Y. Fong, MD
P. J. Allen, MD
M. I. D’Angelica, MD
W. R. Jarnagin, MD
Publication date
01-08-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 8/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-2975-9

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