Trends and Outcomes of Synchronous Resection of Colorectal Metastasis in the Modern Era—Analysis of Targeted Hepatic NSQIP Database

• Published in: The Journal of surgical research Vol. 238; pp. 35 - 40
• Main Authors: Jones, Tyler J., Murphy, Amy E., Tameron, Ashley, Hussain, Lala R., Grannan, Kevin, Guend, Hamza, Dunki-Jacobs, Erik M., Lee, David Y.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2019
• Subjects: Aged; Colectomy - adverse effects; Colectomy - methods; Colectomy - trends; Colon - surgery; Colorectal liver metastasis; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - therapy; Female; Hepatectomy - adverse effects; Hepatectomy - methods; Hepatectomy - trends; Hepatic metastasis; Hepatic resection for colorectal liver metastasis; Hospital Mortality; Humans; Incidence; Liver - surgery; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - therapy; Liver resection; Male; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - trends; Neoadjuvant Therapy - statistics & numerical data; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Proctectomy - adverse effects; Proctectomy - methods; Proctectomy - trends; Retrospective Studies; Simultaneous liver and colon resection; Stage IV colon cancer; Survival Analysis; Synchronous resection; Liver resection; Colorectal liver metastasis; Hepatic resection for colorectal liver metastasis; Stage IV colon cancer; Synchronous resection; Hepatic metastasis; Simultaneous liver and colon resection
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2019.01.021

Previous studies using the NSQIP database to study hepatectomies lacked hepatic specific variables and outcomes. We used the targeted NSQIP hepatectomy database to examine the nationwide trend and the safety profile of synchronous liver and colorectal resection compared with hepatectomy alone for colorectal liver metastasis.
The targeted NSQIP hepatectomy database from 2014 was used to study patients who underwent hepatectomy for diagnosis of adenocarcinoma of the colon and rectum.
Of the 3064 hepatic resections in the database, 1138 cases were performed for colorectal metastasis. Of these, 1040 were liver-alone surgery and 98 were synchronous liver and colorectal resection. Most (58.7%) patients received neoadjuvant therapy. The rate of neoadjuvant therapy, intraoperative ablation, biliary reconstruction, and the use of minimally invasive technique were similar between the two groups. The overall 30-d mortality in this cohort was low (1.1%). While the mortality rate in the synchronous group was similar to liver-only group (3.1% versus 0.9%, P = 0.077). The rate of liver failure (3.3% versus 4.1%, P = 0.722) and biliary leak (5.3% versus 9.6%, P = 0.084) were similar between the two groups. However, the rate of major complications was higher on multivariable analyses (25.5% versus 12.1%, OR 2.5, 95% CI 1.5-4.1, P < 0.001) for the synchronous group.
Hepatic resection for colorectal metastasis in the modern era has low short-term mortality. While synchronous resection was associated with a higher incidence of major complications, liver-specific complications did not increase with synchronous resection.