Advertisement

International Journal of Colorectal Disease

, Volume 29, Issue 6, pp 729–735 | Cite as

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

  • Shaun P. McKenzie
  • H. David Vargas
  • B. Mark Evers
  • Daniel L. Davenport
Original Article

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.

Keywords

Colorectal cancer Hepatectomy Resection Metastases Morbidity 

References

  1. 1.
    Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59:225–249PubMedCrossRefGoogle Scholar
  2. 2.
    Chafai N, Chan CL, Bokey EL, Dent OF, Sinclair G, Chapuis PH (2005) What factors influence survival in patients with unresected synchronous liver metastases after resection of colorectal cancer? Colorectal Dis 7:176–181PubMedCrossRefGoogle Scholar
  3. 3.
    Rougier P, Milan C, Lazorhtes F, Fourtanier G, Partensky C, Baumel H, Faivre J (1995) Prospective study of prognostic factors in patients with unresected hepatic metastases from colorectal cancer. Br J Surg 82:1397–1400PubMedCrossRefGoogle Scholar
  4. 4.
    Stangl R, Altendorf-Hofmann A, Charnley RM, Scheele J (1994) Factors influencing the natural history of colorectal liver metastases. Lancet 343:1405–1410PubMedCrossRefGoogle Scholar
  5. 5.
    Al-asfoor A, Fedorowicz Z, Lodge M (2008) Resection versus no intervention or other surgical interventions for colorectal metastases. Cochrane Database Syst Rev CD006039Google Scholar
  6. 6.
    Tomlinson J, Jarnagin W, DeMatteo R, Fong Y, Kornprat P, Gonen M, Kemeny N, Brennan MF, Blumgart LH, D’Angelica M (2008) Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol 25:4575–4580CrossRefGoogle Scholar
  7. 7.
    Pawlik T, Scoggins C, Zorzi D, Abdalla EK, Andres A, Eng C, Curley SA, Loyer EM, Muratore A, Mentha G, Capussotti L, Cauthey JN (2005) Effect of surgical margin status on survival and recurrence after hepatic resection of colorectal metastases. Ann Surg 241:715–724PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Portier G, Elias D, Bouche O, Rougier P, Bosset JF, Saric J, Belghiti J, Piedbois P, Guimbaud R, Nordinger B, Bugat R, Lazorthes F, Bedenne L (2006) Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases: FFCD ACHBTH AURC 9002 trial. J Clin Oncol 24:4976–4982PubMedCrossRefGoogle Scholar
  9. 9.
    Aloia T, Vauthey J, Loyer E, Ribero D, Pawlik TM, Wei SH, Curley SA, Zorzi D, Abdalla EK (2006) Solitary colorectal liver metastasis: resection determined outcome. Arch Surg 141:460–466PubMedCrossRefGoogle Scholar
  10. 10.
    Fong Y, Fortner J, Sun R, Brennan M, Blumgart L (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Minagawa M, Makuuchi M, Torzilli G, Takayama T, Kawasaki S, Kosuge T, Yamamoto J, Imamura H (2000) Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long term results. Ann Surg 231:487–499PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Bolton J, Fuhrman G (2000) Survival after resection of multiple bilobar hepatic metastases from colorectal carcinoma. Ann Surg 231:743–751PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Choti M, Sitzmann J, Tiburi M, Sumetchotimetha W, Rangsin R, Schulick RD, Lillemoe KD, Yeo CJ, Cameron JL (2002) Trends in long term survival following liver resection for hepatic colorectal metastases. Ann Surg 235:759–766PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    De Santibanes E, Lasalle F, McCormack L, Pekolj J, Quintana GO, Vaccaro C, Benati M (2002) Simultaneous colorectal and hepatic resections for colorectal cancer: postoperative and long term outcomes. J Am Coll Surg 195:196–202PubMedCrossRefGoogle Scholar
  15. 15.
    Reddy S, Barbas A, Clary B (2009) Synchronous colorectal liver metastases: is it time to reconsider traditional paradigms of management? Ann Surg Oncol 16:2395–2410PubMedCrossRefGoogle Scholar
  16. 16.
    Hillingso J, Willie-Jorgensen P (2008) Staged or simultaneous resection of synchronous liver metastases from colorectal cancer—a systematic review. Colorectal Dis 11:3–10PubMedCrossRefGoogle Scholar
  17. 17.
    Brouquet A, Mortenson M, Vauthey J, Rodriguez-Bigas MA, Overman MJ, Chang GJ, Kopetz S, Garrett C, Curley SA, Abdalla EK (2010) Surgical strategies for synchronous colorectal liver metastases in 156 consecutive patients: classic, combined, or reverse strategy? J Am Coll Surg 210:934–941PubMedCrossRefGoogle Scholar
  18. 18.
    Minagawa M, Yamamoto J, Miwa S, Sakamoto Y, Kokudo N, Kosuge T, Miyagawa S, Maskuuchi M (2006) Selection criteria for simultaneous resection in patients with synchronous liver metastasis. Arch Surg 141:1006–1012PubMedCrossRefGoogle Scholar
  19. 19.
    Reddy S, Pawlik T, Zorzi D, Gleisner AL, Ribero D, Assumpcao L, Barbas AS, Abdalla EK, Choti MA, Vauthey JN, Ludwig KA, Mantyh CR, Morse MA, Clary BM (2007) Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol 14:3481–3491PubMedCrossRefGoogle Scholar
  20. 20.
    Thelen A, Jonas S, Benckert C, Spinelli A, Lopez-Hänninen E, Rudolph B, Neumann U, Neuhasus P (2007) Simultaneous versus staged liver resection of synchronous liver metastases from colorectal cancer. Int J Colorectal Dis 22:1269–1276PubMedCrossRefGoogle Scholar
  21. 21.
    Jovine E, Biolchini F, Talarico F, Lerro FM, Mastrangelo L, Selleri S, Landolfo G, Martuzzi F, Iusco DR, Lazzari A (2006) Major hepatectomy in patients with synchronous colorectal liver metastases: whether or not a contraindication to simultaneous colorectal and liver resection? Colorectal Dis 9:245–252CrossRefGoogle Scholar
  22. 22.
    Martin R, Paty P, Fong Y et al (2003) Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 197:233–242PubMedCrossRefGoogle Scholar
  23. 23.
    Martin R, Augenstein V, Reuter N, Scoggins C, McMasters K (2009) Simultaneous versus staged resection for synchronous colorectal cancer liver metastases. J Am Coll Surg 208:842–852PubMedCrossRefGoogle Scholar
  24. 24.
    Abbott DE, Cantor SB, Hu CY, Aloia TA, You YN, Nouyen S, Chang GJ (2012) Optimizing clinical and economic outcomes of surgical therapy for patients with colorectal cancer and synchronous liver metastases. J Am Coll Surg 215:262–70PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Fink AS, Campbell DA Jr, Mentzer RM Jr, Henderson WG, Daley J, Bannister J, Hur K, Khuri SF (2002) The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility. Ann Surg 236:344–353, discussion 353–354PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Worni M, Mantyh C, Akushevich I, Pietrobon R, Clary B (2012) Is there a role for simultaneous hepatic and colorectal resections? A contemporary view from NSQIP. J Gastrointest Surg 16:2074–2085PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Shaun P. McKenzie
    • 1
  • H. David Vargas
    • 2
  • B. Mark Evers
    • 1
  • Daniel L. Davenport
    • 1
    • 3
  1. 1.Department of SurgeryUniversity of KentuckyLexingtonUSA
  2. 2.Department of Colon and Rectal SurgeryOchsner Health SystemNew OrleansUSA
  3. 3.Department of SurgeryUniversity of KentuckyLexingtonUSA

Personalised recommendations