Abstract
Background
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.
Methods
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.
Results
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).
Conclusion
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.
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Article info
Publication history
Published online: January 03, 2023
Accepted:
December 31,
2022
Received:
August 14,
2022
Footnotes
Presented in part at the Americas Hepato-Pancreato-Biliary Association 2021 Annual Meeting, August 2–5, 2021.
Identification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
