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

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    C. Correa-Gallego 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

  2. Department of Epidemiology-Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    M. Gonen PhD

  3. Department of Anesthesiology and Critical Care, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    M. Fischer MD, F. Grant MD & V. Arslan-Carlon MD

  4. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    N. E. Kemeny MD

Authors
  1. C. Correa-Gallego MD
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  2. M. Gonen PhD
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  3. M. Fischer MD
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  4. F. Grant MD
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  5. N. E. Kemeny MD
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  6. V. Arslan-Carlon MD
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  7. T. P. Kingham MD
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  8. R. P. DeMatteo MD
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  9. Y. Fong MD
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  10. P. J. Allen MD
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  11. M. I. D’Angelica MD
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  12. W. R. Jarnagin MD
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Corresponding author

Correspondence to W. R. Jarnagin MD.

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Correa-Gallego, C., Gonen, M., Fischer, M. et al. Perioperative complications influence recurrence and survival after resection of hepatic colorectal metastases. Ann Surg Oncol 20, 2477–2484 (2013). https://doi.org/10.1245/s10434-013-2975-9

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  • DOI: https://doi.org/10.1245/s10434-013-2975-9

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