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Postoperative Complications Affect Long-Term Survival Outcomes Following Hepatic Resection for Colorectal Liver Metastasis

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Abstract

Background

The impact of postoperative complications (POCs) on long-term survival outcomes following hepatic resection for colorectal liver metastasis (CRLM) is in controversy. The aim of the present meta-analysis was to systematically evaluate the POC effect on overall survival (OS) and disease-free survival (DFS) in patients undergoing hepatic resection for CRLM.

Methods

We conducted a systematic review and meta-analysis of all observational studies to evaluate the POC effect on OS and DFS in patients undergoing hepatic resection for CRLM. A search for all major databases and relevant journals from inception to January 2014 without restriction on languages or regions was performed. POCs were extracted and graded according to a validated system of classification. Outcome measures were postoperative 1-, 2-, 3-, and 10-year OSs and DFSs. Both random-effects and fixed-effect models were used to pool the hazard ratios (HRs) of the survival outcomes. Test of heterogeneity was performed with the Q statistic.

Results

A total of 2370 patients were included in the meta-analysis. Both 5- and 10-year postoperative OSs showed significant decreases in patients with POCs (HR = 1.52; 95 % CI 1.27–1.83; P < 0.001 and HR = 1.36; 95 % CI 1.18–1.58; P < 0.001, respectively). Similar outcomes were also observed in terms of DFSs, with the 5- and 10-year HRs found to be 1.37 (95 % CI 1.23–1.53; P < 0.001) and 1.34 (95 % CI 1.17–1.53; P < 0.001), respectively, compared to no POC group.

Conclusions

POCs are strongly related to long-term oncologic outcomes following hepatic resection for CRLM. Further efforts to refine surgical technique and postoperative management to avoid complications may improve the long-term oncological outcomes of the selected patients.

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Acknowledgments

The authors thank Prof. Yuan-Tao Hao, Department of Medical Statistics, Sun Yat-sen University, Guangdong, China, for statistical advice; Yu Bai, Department of Gastroenterology of Affiliated Changhai Hospital, Second Military Medical University, Shanghai, China, for research comments; and Yan Jia, Medical Library of North Campus, Sun Yat-sen University, Guangdong, China, for literature search. None of these persons received compensation for the work performed. This study was not supported by any pharmaceutical company or Grants; the cost was borne by the authors’ institutions.

Conflicts of interest

Consents to publication were all available for all authors. The authors declare no conflicts of interest.

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    Authors and Affiliations

    1. General Surgery Department of Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Rd., Guangzhou, 510080, China

      Zi Yin, Haosheng Jin, Ye Lin, Min Yu & Zhixiang Jian

    2. Department of Urology, Gansu Provincial Hospital, Lanzhou, China

      Xiande Huang

    3. Gynaecology and Obstetrics Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

      Tingting Ma

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    1. Zi Yin
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    Correspondence to Zi Yin or Zhixiang Jian.

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    Zi Yin, Xiande Huang and Tingting Ma contributed equally to this work.

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    Yin, Z., Huang, X., Ma, T. et al. Postoperative Complications Affect Long-Term Survival Outcomes Following Hepatic Resection for Colorectal Liver Metastasis. World J Surg 39, 1818–1827 (2015). https://doi.org/10.1007/s00268-015-3019-3

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