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Simultaneous Hepatic and Visceral Resection: Preoperative Risk Stratification and Implications on Return to Intended Oncologic Therapy

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

Abstract

Purpose

Sequence of therapies for synchronous liver metastasis (LM) is complex, with data supporting individualized approaches, although no guiding tools are currently available. We assessed the impact of simultaneous hepatic and visceral resections (SHVR) on textbook outcome (TO) and return to intended oncologic therapy (RIOT), and provide risk-stratification tools to guide individualized decision making and counseling.

Methods

Patients with synchronous LM undergoing hepatectomy ± SHVR were included (2015–2021). Primary and secondary outcomes were TO and RIOT (days), respectively. Using multivariable modeling, a risk score for TO was developed. Decision tree analysis using recursive partitioning was performed for hierarchical risk stratification. The associations between SHVR, TO, and RIOT were examined.

Results

Among 533 patients identified, 124 underwent SHVR. TO overall was 71.7%; 79.2% in the non-SHVR group and 46.8% in the SHVR group (p < 0.001). SHVR was the strongest predictor of non-TO (right colon/small bowel: odds ratio [OR] 4.63, 95% confidence interval [CI] 2.65–8.08; left colon/rectum: OR 6.09, 95% CI 2.59–14.3; stomach/pancreas: OR 6.69, 95% CI 1.46–30.7; multivisceral: OR 10.9, 95% CI 3.03–39.5). A composite score was developed yielding three risk strata for TO (score 0–2: 89% vs. score 3–5: 67% vs. score ≥ 6: 37%; p < 0.001). Decision tree analysis was congruent, identifying SHVR as the most important determinant of TO. In patients with colorectal LM, SHVR was associated with delayed time to RIOT (p = 0.004); the risk-stratification tool for TO was equally predictive of RIOT (p < 0.01).

Conclusions

SHVR is associated with reduced likelihood of TO and in turn delayed RIOT. As SHVR is increasingly performed in order to consolidate cancer care, patient selection considering these different outcomes is critical.

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Funding

This study was supported in part by the Hepatobiliary Donor Fund, Moffitt Cancer Center. This study was reviewed and approved by the Institutional Review Board at Moffitt Cancer Center.

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Authors and Affiliations

  1. Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Andrew J. Sinnamon MD, MSCE, Sarah Zhu PA-C, Jason W. Denbo MD, Jason B. Fleming MD & Daniel A. Anaya MD

  2. University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Andrew J. Sinnamon MD, MSCE, Eric Luo BS & Aileen Xu BS, MPH

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  1. Andrew J. Sinnamon MD, MSCE
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Correspondence to Andrew J. Sinnamon MD, MSCE.

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Sinnamon, A.J., Luo, E., Xu, A. et al. Simultaneous Hepatic and Visceral Resection: Preoperative Risk Stratification and Implications on Return to Intended Oncologic Therapy. Ann Surg Oncol 30, 1772–1783 (2023). https://doi.org/10.1245/s10434-022-12834-0

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