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Multivariate Analysis of Predictive Factors for Early Postoperative Death After Colorectal Surgery in Patients with Colorectal Cancer and Synchronous Unresectable Liver Metastases

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Diseases of the Colon & Rectum

Abstract

Purpose

Surgery of the primary tumor in patients with colorectal cancer and unresectable synchronous liver metastases remains controversial. This study was designed to evaluate predictive preoperative factors of early postoperative death (<3 months) in such patients.

Methods

This study included 80 patients who underwent colorectal resection (n--6) or diversion stoma (n--4) for colorectal cancer with unresectable liver metastases. Twenty-two patients (28 percent) died during the first three months after surgery with two (2.5 percent) in-hospital postoperative deaths. Analysis of predictive preoperative factors for three-month postoperative death risk was performed.

Results

In univariate analysis, age older than 75 years (P--.01), American Society of Anesthesiologists grade > II (P--.009), symptomatic patient (P--.01), bowel obstruction (P--.03), aspartate aminotransferase serum level >50 (1.5 N) IU/L (P--.008), and alkaline phosphatase >200 (2 N) IU/L (P--.02) were prognostic risk factors for three-month death after surgery. In multivariate analysis, age older than 75 years (relative risk--.9; P--.04) and aspartate aminotransferase serum level >50 IU/L (relative risk--.3; P--.03) were independent risk factors.

Conclusions

In patients with colorectal cancer and synchronous unresectable liver metastases, the three-month mortality rate was high (28 percent). Thus, better knowledge of risk factors could help select patients who could possibly benefit from surgery. The study suggested that age older than 75 years and liver cytolysis (>1.5 N) are associated with an increased three-month postoperative death risk. In these patients, surgery should be avoided.

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Acknowledgement

The authors thank Edouardo Flores Rivera, M.D. for assistance.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Beaujon Hospital, Clichy, France

    Frederic Bretagnol M.D., Arnaud Alves M.D. & Yves Panis M.D.

  2. Department of Digestive Surgery, Lariboisiere Hospital, Paris, France

    Eric Vibert M.D., Marc Pocard M.D. & Patrice Valleur M.D.

  3. Service de Chirurgie Colorectale (Pôle des maladies de l’Appareil Digestif PMAD), Hôpital Beaujon (APHP), 100 boulevard Général Leclerc, 92118, Clichy cedex, France

    Yves Panis M.D.

Authors
  1. Eric Vibert M.D.
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  2. Frederic Bretagnol M.D.
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  3. Arnaud Alves M.D.
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  4. Marc Pocard M.D.
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  5. Patrice Valleur M.D.
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  6. Yves Panis M.D.
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Corresponding author

Correspondence to Yves Panis M.D..

Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, April 30 to May 5, 2005.

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Vibert, E., Bretagnol, F., Alves, A. et al. Multivariate Analysis of Predictive Factors for Early Postoperative Death After Colorectal Surgery in Patients with Colorectal Cancer and Synchronous Unresectable Liver Metastases. Dis Colon Rectum 50, 1776–1782 (2007). https://doi.org/10.1007/s10350-007-9025-2

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  • DOI: https://doi.org/10.1007/s10350-007-9025-2

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