Severe Preoperative Symptoms Delay Readiness to Return to Intended Oncologic Therapy (RIOT) After Liver Resection

  • Heather A. Lillemoe
  • Rebecca K. Marcus
  • Bradford J. Kim
  • Nisha Narula
  • Catherine H. Davis
  • Qiuling Shi
  • Xin Shelley Wang
  • Thomas A. AloiaEmail author
Hepatobiliary Tumors



Symptom burden, as measured by patient-reported outcome (PRO) metrics, may have prognostic value in various cancer populations, but remains underreported. The aim of this project was to determine the predictive impact of preoperative patient-reported symptom burden on readiness to return to intended oncologic therapy (RIOT) after oncologic liver resection.


Preoperative factors, including anthropometric analysis of sarcopenia, were collected for patients undergoing oncologic liver resection from 2015 to 2018. All patients reported their preoperative symptom burden using the MD Anderson Symptom Inventory, Gastrointestinal version (MDASI-GI). Time to RIOT readiness was compared using standard statistics.


Preoperative symptom burden was measured in 107 consecutive patients; 52% had at least one moderate symptom score and 21% reported at least one severe score. Highest rated symptoms were fatigue, disturbed sleep, and distress. For patients reporting a severe preoperative symptom burden, the median time to RIOT readiness was 35 days (interquartile range [IQR] 28–42), compared with 21 days (IQR 21–28) for those without severe symptoms (p < 0.001). On multivariable analysis, severe preoperative symptom burden was independently associated with longer time to RIOT readiness (estimate +7.5 days, 95% confidence interval 2.6–12.3; p = 0.002).


Preoperative symptom burden has a substantial impact on time to RIOT readiness, leading to, on average, a 7-day delay in RIOT readiness compared with patients without severe preoperative symptoms. Identifying and targeting severe preoperative symptoms may hasten recovery and improve time to necessary adjuvant therapies.



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


Dr. Heather Lillemoe is supported by National Institutes of Health grant T32CA009599 and MD Anderson Cancer Center support Grant P30 CA016672. Dr. Xin Shelley Wang is supported by Grants from the US National Cancer Institute (R01 CA205146).

Supplementary material

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Supplementary material 1 (DOCX 13 kb)


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Heather A. Lillemoe
    • 1
  • Rebecca K. Marcus
    • 1
  • Bradford J. Kim
    • 1
  • Nisha Narula
    • 1
  • Catherine H. Davis
    • 1
  • Qiuling Shi
    • 2
  • Xin Shelley Wang
    • 2
  • Thomas A. Aloia
    • 1
    Email author
  1. 1.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Symptom ResearchThe University of Texas MD Anderson Cancer CenterHoustonUSA

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