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Detours on the Road to Recovery: What Factors Delay Readiness to Return to Intended Oncologic Therapy (RIOT) After Liver Resection for Malignancy?

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Poor recovery after oncologic hepatic resection delays Return to Intended Oncologic Therapy (RIOT) and shortens survival. In order to identify at-risk patients, this study was designed to determine which psychosocial and perioperative factors are associated with delayed RIOT readiness.

Methods

A prospectively maintained database was queried to identify consecutive patients undergoing hepatectomy for malignancy from 2015 to 2017. Perioperative factors were compared between patients with early (≤ 28 postoperative days) vs. delayed (> 28 postoperative days) clearance to RIOT. Univariate analysis and multivariable logistic regression were performed.

Results

Of 114 patients, 76 patients (67%) had an open surgical approach, 32 (28%) had a major hepatectomy, and 6 (5%) had a major complication, with no mortalities. Eighty-two patients (72%) had early and 32 patients (28%) had delayed RIOT readiness. Patients with high preoperative symptom burden were more likely to have delayed RIOT readiness (OR 3.1, 95% CI 1.1–8.4, p = 0.024). On multivariable analysis, open surgical approach (OR 6.9, 95% CI 1.4–34.7, p = 0.018), length of stay > 5 days (OR 3.6, 95% CI 1.4–9.4, p = 0.010), and any complication (OR 3.4, 95% CI 1.1–10.7, p = 0.033) were associated with delayed RIOT readiness. Postoperative factors associated with delayed RIOT readiness included nutritional and wound-healing parameters.

Conclusions

This study highlights the previously under-described importance of preoperative patient symptom burden on delayed postoperative recovery. As a cancer patient’s return to oncologic therapy after hepatectomy has a substantial impact on survival, it is critical to adhere to enhanced recovery principles and address all other modifiable factors that delay recovery.

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Acknowledgements

The authors thank Brigitte M. Taylor (Department of Surgical Oncology, MD Anderson Cancer Center) for the secretarial assistance in the preparation of the manuscript.

Statement of Author Contribution

  • Substantial contributions to:

    • The conception or design of the work: HL, RM, TA

    • The acquisition, analysis, or interpretation of data for the work: HL, RM, BK, NN, CD, TA

  • Drafting the work or revising it critically for important intellectual content: all authors

  • Final approval of the version to be published: all authors

  • Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors

Funding Sources

Drs. Heather Lillemoe, Rebecca Marcus, Nisha Narula, and Bradford Kim are/were supported by National Institutes of Health grant T32CA009599 and the MD Anderson Cancer Center support grant (P30 CA016672).

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Author notes

  1. Heather A. Lillemoe and Rebecca K. Marcus contributed equally to this work.

Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Heather A. Lillemoe, Rebecca K. Marcus, Bradford J. Kim, Nisha Narula, Catherine H. Davis & Thomas A. Aloia

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  1. Heather A. Lillemoe
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  2. Rebecca K. Marcus
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Correspondence to Thomas A. Aloia.

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This study was presented on June 4, 2018 at the 59th Annual Meeting of the Society for Surgery of the Alimentary Tract, Washington, DC.

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Lillemoe, H.A., Marcus, R.K., Kim, B.J. et al. Detours on the Road to Recovery: What Factors Delay Readiness to Return to Intended Oncologic Therapy (RIOT) After Liver Resection for Malignancy?. J Gastrointest Surg 23, 2362–2371 (2019). https://doi.org/10.1007/s11605-019-04165-5

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