TY - JOUR
T1 - Impact of cumulative operative time on postoperative complication risk in simultaneous resections of colorectal liver metastases and primary tumors
AU - Martin, Allison N.
AU - Tzeng, Ching Wei D.
AU - Arvide, Elsa M.
AU - Skibber, John M.
AU - Chang, George J.
AU - Nancy You, Yi Qian
AU - Bednarski, Brian K.
AU - Uppal, Abhineet
AU - Dewhurst, Whitney L.
AU - Cristo, Jenilette V.
AU - Chun, Yun S.
AU - Tran Cao, Hop S.
AU - Vauthey, Jean Nicolas
AU - Newhook, Timothy E.
N1 - Publisher Copyright:
© 2023 International Hepato-Pancreato-Biliary Association Inc.
PY - 2023/3
Y1 - 2023/3
N2 - Background: Simultaneous resection of colorectal liver metastases (CLM) and primary colorectal cancers (CRC) is nuanced without firm rules for selection. This study aimed to identify factors associated with morbidity after simultaneous resection. Methods: Using a prospective database, patients undergoing simultaneous CLM-CRC resection from 1/1/2017-7/1/2020 were analyzed. Regression modeling estimated impact of colorectal resection type, Kawaguchi–Gayet (KG) hepatectomy complexity, and perioperative factors on 90-day complications. Results: Overall, 120 patients underwent simultaneous CLM-CRC resection. Grade≥2 complications occurred in 38.3% (n = 46); these patients experienced longer length of stay (median LOS 7.5 vs. 4, p < 0.001) and increased readmission (39% vs. 1.4%, p < 0.001) compared to patients with zero or Grade 1 complications. Median OR time was 298 min. Patients within highest operative time quartile (>506 min) had higher grade≥2 complications (57%vs. 23%, p = 0.04) and greater than 4-fold increased odds of grade≥2 morbidity (OR 4.3, 95% CI (Confidence Interval) 1.41–13.1, p = 0.01). After adjusting for Pringle time, KG complexity and colorectal resection type, increasing operative time was associated with grade≥2 complications, especially for resections in highest quartile of operative time (OR 7.28, 95% CI 1.73–30.6, p = 0.007). Conclusion: In patients undergoing simultaneous CLM-CRC resection, prolonged operative time is independently associated with grade≥2 complications. Awareness of cumulative operative time may inform intraoperative decision-making by surgical teams.
AB - Background: Simultaneous resection of colorectal liver metastases (CLM) and primary colorectal cancers (CRC) is nuanced without firm rules for selection. This study aimed to identify factors associated with morbidity after simultaneous resection. Methods: Using a prospective database, patients undergoing simultaneous CLM-CRC resection from 1/1/2017-7/1/2020 were analyzed. Regression modeling estimated impact of colorectal resection type, Kawaguchi–Gayet (KG) hepatectomy complexity, and perioperative factors on 90-day complications. Results: Overall, 120 patients underwent simultaneous CLM-CRC resection. Grade≥2 complications occurred in 38.3% (n = 46); these patients experienced longer length of stay (median LOS 7.5 vs. 4, p < 0.001) and increased readmission (39% vs. 1.4%, p < 0.001) compared to patients with zero or Grade 1 complications. Median OR time was 298 min. Patients within highest operative time quartile (>506 min) had higher grade≥2 complications (57%vs. 23%, p = 0.04) and greater than 4-fold increased odds of grade≥2 morbidity (OR 4.3, 95% CI (Confidence Interval) 1.41–13.1, p = 0.01). After adjusting for Pringle time, KG complexity and colorectal resection type, increasing operative time was associated with grade≥2 complications, especially for resections in highest quartile of operative time (OR 7.28, 95% CI 1.73–30.6, p = 0.007). Conclusion: In patients undergoing simultaneous CLM-CRC resection, prolonged operative time is independently associated with grade≥2 complications. Awareness of cumulative operative time may inform intraoperative decision-making by surgical teams.
UR - http://www.scopus.com/inward/record.url?scp=85147370452&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85147370452&partnerID=8YFLogxK
U2 - 10.1016/j.hpb.2022.12.008
DO - 10.1016/j.hpb.2022.12.008
M3 - Article
C2 - 36697350
AN - SCOPUS:85147370452
SN - 1365-182X
VL - 25
SP - 347
EP - 352
JO - HPB
JF - HPB
IS - 3
ER -