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Hepatic, colorectal resections influence mortality and morbidity in CRC

Colorectal and hepatic resections for stage 4 metastatic colorectal cancer influenced postoperative outcomes, with minor hepatectomy associated with lower rates of mortality and major morbidity and major hepatectomies associated with higher rates of both, according to published findings.

“To our knowledge, this study is the first large multi-institutional investigation assessing operative morbidity and mortality after synchronous surgical management of stage 4 colorectal cancer by stratifying synchronous colorectal and hepatic resections by both the extent and risk of the hepatectomy as well as the type of risk of the colorectal resection,” the researchers wrote.  

Researchers retrospectively reviewed data of 43,408 patients for mortality and major morbidity after isolated hepatectomy (n = 6,661), isolated colorectal resection (CRR; n = 35,825) and synchronous resection (n = 922) for colorectal cancer, from the American College of Surgeons-National Surgical Quality Improvement Program database between 2005 and 2013. The hepatectomy and CRR risk categories were created based on mortality and major morbidity of patients with isolated resections. Then, the synchronous group was stratified based on risk categories.

“Cumulative asynchronous mortality and [major morbidity] were estimated compared to that observed in the synchronous cohort via unadjusted relative risk and risk difference,” the researchers wrote.

Overall, isolated hepatectomy patients with trisectionectomy and right hepatectomy experienced the highest mortality. Among isolated CRR patients, diverted left colectomy, abdominoperineal resection, total abdominal colectomy and total abdominal proctocolectomy had the highest major morbidity.

The mortality of minor hepatectomies (0.6%) was lower compared with major hepatectomies (2.2%; P < .001). Major morbidity was lower in the minor hepatectomy group (11%) compared with the major hepatectomy group (20.8%; P < .001). Among synchronous patients, mortality varied between 0.9% and 5% and major morbidity varied between 25.5% and 55%.

Analyses showed that as CRR and hepatectomy risk categories increased, mortality and major morbidity increased among synchronous patients. Mortality rate was lower after synchronous minor hepatectomy and either low or high risk CRR. Also, mortality and major morbidity did not differ significantly after major hepatectomy with “either high or low risk CRR,” the researchers wrote.

The researchers concluded: “Major morbidity after synchronous hepatic and colorectal resections vary incrementally and are related to both the risk of hepatectomy and CRR. Stratification of outcomes by the hepatectomy and CRR components may reflect a more accurate description of risks. Comparison of synchronous and combined outcomes of individual operations supports a potential benefit for synchronous resections with minor hepatectomy.” – by Melinda Stevens

Disclosures: Healio.com/Hepatology was unable to confirm relevant financial disclosures at the time of publication.