Simultaneous resection of colorectal liver metastases (CLM) and primary colorectal cancers (CRC) is nuanced without firm rules for selection. This study aimed to identify factors associated with morbidity after simultaneous resection.
Using a prospective database, patients undergoing simultaneous CLM-CRC resection from 1/1/2017-7/1/2020 were analyzed. Regression modeling estimated impact of colorectal resection type, Kawaguchi–Gayet (KG) hepatectomy complexity, and perioperative factors on 90-day complications.
Overall, 120 patients underwent simultaneous CLM-CRC resection. Grade≥2 complications occurred in 38.3% (n = 46); these patients experienced longer length of stay (median LOS 7.5 vs. 4, p < 0.001) and increased readmission (39% vs. 1.4%, p < 0.001) compared to patients with zero or Grade 1 complications. Median OR time was 298 min. Patients within highest operative time quartile (>506 min) had higher grade≥2 complications (57%vs. 23%, p = 0.04) and greater than 4-fold increased odds of grade≥2 morbidity (OR 4.3, 95% CI (Confidence Interval) 1.41–13.1, p = 0.01). After adjusting for Pringle time, KG complexity and colorectal resection type, increasing operative time was associated with grade≥2 complications, especially for resections in highest quartile of operative time (OR 7.28, 95% CI 1.73–30.6, p = 0.007).
In patients undergoing simultaneous CLM-CRC resection, prolonged operative time is independently associated with grade≥2 complications. Awareness of cumulative operative time may inform intraoperative decision-making by surgical teams.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to HPB
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Incidence and predictors of textbook outcome after simultaneous liver and rectal surgeries for Stage IV rectal cancer.Colorectal Dis. 2021; 24: 50-58
- The impact of synchronous liver resection on the risk of anastomotic leakage following elective colorectal resection. A propensity score match analysis on behalf of the iCral study group.Eur J Surg Oncol. 2021; 47: 2873-2879
- Thirty-day morbidity after simultaneous resection of colorectal cancer and colorectal liver metastasis: American College of surgeons NSQIP analysis.J Am Coll Surg. 2020; 230 (e619): 617-627
- Surgical strategies for synchronous colorectal liver metastases in 156 consecutive patients: classic, combined or reverse strategy?.J Am Coll Surg. 2010; 210: 934-941
- Choices of therapeutic strategies for colorectal liver metastases among expert liver surgeons: a throw of the dice?.Ann Surg. 2020; 272: 715-722
- Major liver resections synchronous with colorectal surgery.Ann Surg Oncol. 2007; 14: 195-201
- Outcomes of simultaneous major liver resection and colorectal surgery for colorectal liver metastases.J Gastrointest Surg. 2016; 20: 554-563
- Difficulty of laparoscopic liver resection: proposal for a new classification.Ann Surg. 2018; 267: 13-17
- Performance of a modified three-level classification in stratifying open liver resection procedures in terms of complexity and postoperative morbidity.Br J Surg. 2020; 107: 258-267
- Validation and performance of three-level procedure-based classification for laparoscopic liver resection.Surg Endosc. 2020; 34: 2056-2066
- Comparative performance of the complexity classification and the conventional major/minor classification for predicting the difficulty of liver resection for hepatocellular carcinoma.Ann Surg. 2018; 267: 18-23
- Risk-stratified post-hepatectomy pathways based upon the kawaguchi-gayet complexity classification and impact on length of stay.Surgery Open Science. 2022; 9: 109-116
- Surgical approach to synchronous colorectal liver metastases: staged, combined, or reverse strategy.Hepatobiliary Surg Nutr. 2020; 9: 25-34
- Active surveillance for adverse events within 90 Days: the standard for reporting surgical outcomes after pancreatectomy.Ann Surg Oncol. 2015; 22: 3522-3529
- Should we evaluate liver resection difficulty by separating laparoscopic from open approaches?.Ann Surg. 2018; 268: e90-e91
- Two-surgeon technique for hepatic parenchymal transection of the noncirrhotic liver using saline-linked cautery and ultrasonic dissection.Ann Surg. 2005; 242: 172-177
- The accordion severity grading system of surgical complications.Ann Surg. 2009; 250: 177-186
- Assessment of complications after liver surgery: two novel grading systems applied to patients undergoing hepatectomy.J Huazhong Univ Sci Technolog Med Sci. 2017; 37: 352-356
- Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastases.J Gastrointest Surg. 2010; 14: 1974-1980
- A NSQIP Review of major morbidity and mortality of synchronous liver resection for colorectal metastasis stratified by extent of liver resection and type of colorectal resection.J Gastrointest Surg. 2015; 19: 1982-1994
- Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary.Br J Surg. 2006; 93: 872-878
- Liver-first approach for synchronous colorectal metastases: analysis of 7360 patients from the LiverMetSurvey registry.Ann Surg Oncol. 2021; 28: 8198-8208
- Primary tumor resection plus chemotherapy versus chemotherapy alone for colorectal cancer patients with asymptomatic, synchronous unresectable metastases (JCOG1007; iPACS): a randomized clinical trial.J Clin Oncol. 2021; 39: 1098-1107
Published online: January 03, 2023
Accepted: December 31, 2022
Received: August 14, 2022
Presented in part at the Americas Hepato-Pancreato-Biliary Association 2021 Annual Meeting, August 2–5, 2021.
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.