Perioperative complications influence recurrence and survival after resection of hepatic colorectal metastases Journal Article
| Authors: | Correa-Gallego, C.; Gonen, M.; Fischer, M.; Grant, F.; Kemeny, N. E.; Arslan Carlon, V.; Kingham, T. P.; DeMatteo, R. P.; Fong, Y.; Allen, P. J.; D'Angelica, M. I.; Jarnagin, W. R. |
| Article Title: | Perioperative complications influence recurrence and survival after resection of hepatic colorectal metastases |
| Abstract: | Background: Perioperative outcomes, such as blood loss, transfusions, and morbidity, have been linked to cancer-specific survival, but this is largely unsupported by prospective data. Methods: Patients from a previous, randomized trial that evaluated acute normovolemic hemodilution during major hepatectomy (≥3 segments) were reevaluated and those with metastatic colorectal cancer (n = 90) were selected for analysis. Survival data were obtained from the medical record. Disease extent was measured using a clinical-risk score (CRS). Log-rank test and Cox proportional hazard model were used to evaluate recurrence-free survival (RFS) and overall survival (OS). Results: Median follow-up was 71 months. The CRS was ≥3 in 45 % of patients; 59 % had extrahepatic procedures. Morbidity and mortality were 33 and 2 %, respectively. Postoperative chemotherapy was given to 87 % of patients (78/90) starting at a median of 6 weeks. RFS and OS were 29 and 60 months, respectively. Postoperative morbidity significantly reduced RFS (23 vs. 69 months; P < 0.001) and OS (28 vs. 74 months; P < 0.001) on uni- and multi-variate analysis; positive resection margins and high CRS also were significant factors. Delayed initiation of postoperative chemotherapy (≥8 weeks) was common in patients with complications (37 vs. 12 %; P = 0.01). Conclusions: In this selected cohort of patients from a previous RCT, perioperative morbidity was strongly (and independently) associated with cancer-specific outcome. It also was associated with delayed initiation of postoperative chemotherapy, the impact of which on survival is unclear. © 2013 Society of Surgical Oncology. |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 20 |
| Issue: | 8 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2013-08-01 |
| Start Page: | 2477 |
| End Page: | 2484 |
| Language: | English |
| DOI: | 10.1245/s10434-013-2975-9 |
| PROVIDER: | scopus |
| PUBMED: | 23608971 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 August 2013" - "CODEN: ASONF" - "Source: Scopus" |
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