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Selection criteria for combined resection of synchronous colorectal cancer hepatic metastases: a cautionary note

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Combined resection of primary colorectal cancer and synchronous hepatic metastases has been shown to be safe and associated with acceptable oncologic outcomes in selected patients. The purpose of this study was to determine if selection criteria for combined resection could be identified using major morbidity or mortality as an avoidable outcome.

Methods

We queried the American College of Surgeons National Surgery Quality Improvement Program dataset from 2005 to 2010 for combined liver and colorectal resections for colorectal cancer using procedure and diagnosis codes. These patients were compared to colorectal cancer patients receiving colectomy alone and patients receiving liver-directed surgery for secondary liver cancer.

Results

During the study period, 1,641 (53.1 %) of patients underwent colectomy alone, 1,113 (36 %) underwent liver-directed surgery alone, and 334 (10.9 %) underwent combined colectomy and liver-directed surgery for colorectal cancer. The combined patient population had statistically significant increases in American Society of Anesthesiologists class, preoperative ascites, preoperative systemic inflammatory response syndrome/sepsis, weight loss, functional dependence, and decreased serum albumin compared to the other cohorts. While major hepatectomy was less frequent in the combined cohort, the rate of rectal resection was similar to the colectomy-alone cohort. These selection disparities resulted in a subsequent increase in composite major morbidity, return to operating room, infectious complications, and length of stay in combined patients.

Conclusions

While combined resection in patients with synchronous colorectal cancer hepatic metastases may be feasible, it is associated with considerable increase in morbidity without application of stringent selection criteria. We recommend only patients without known risk factors for perioperative morbidity and infectious complications be considered for this approach.

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Author information

Authors and Affiliations

  1. Department of Surgery, University of Kentucky, Lexington, KY, USA

    Shaun P. McKenzie, B. Mark Evers & Daniel L. Davenport

  2. Department of Colon and Rectal Surgery, Ochsner Health System, New Orleans, LA, USA

    H. David Vargas

  3. Department of Surgery, University of Kentucky, 800 Rose Street, Room MN278, Lexington, KY, 40536-0298, USA

    Daniel L. Davenport

Authors
  1. Shaun P. McKenzie
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  2. H. David Vargas
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  3. B. Mark Evers
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  4. Daniel L. Davenport
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Corresponding author

Correspondence to Daniel L. Davenport.

Appendix

Appendix

Table 4 Diagnosis and procedure codes used to identify patients undergoing combined colorectal and liver resections for primary colorectal cancer
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Table 5 Multivariable predictors of mortality and major morbidity or mortality
Full size table

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McKenzie, S.P., Vargas, H.D., Evers, B.M. et al. Selection criteria for combined resection of synchronous colorectal cancer hepatic metastases: a cautionary note. Int J Colorectal Dis 29, 729–735 (2014). https://doi.org/10.1007/s00384-013-1828-0

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  • DOI: https://doi.org/10.1007/s00384-013-1828-0

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