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Alexandrescu ST, Zarnescu NO, Diaconescu AS, Tomescu D, Droc G, Hrehoret D, Brasoveanu V, Popescu I. The Impact of Postoperative Complications on Survival after Simultaneous Resection of Colorectal Cancer and Liver Metastases. Healthcare (Basel) 2022; 10:healthcare10081573. [PMID: 36011230 PMCID: PMC9408276 DOI: 10.3390/healthcare10081573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this study was to investigate the impact of postoperative complications on the long-term outcomes of patients who had undergone simultaneous resection (SR) of colorectal cancer and synchronous liver metastases (SCLMs). Methods: We conducted a single-institution survival cohort study in patients with SR, collecting clinical, pathological, and postoperative complication data. The impact of these variables on overall survival (OS) and disease-free survival (DFS) was compared by log rank test. Multivariate Cox regression analysis identified independent prognostic factors. Results: Out of 243 patients, 122 (50.2%) developed postoperative complications: 54 (22.2%) major complications (Clavien–Dindo grade III–V), 86 (35.3%) septic complications, 59 (24.2%) hepatic complications. Median comprehensive complication index (CCI) was 8.70. Twelve (4.9%) patients died postoperatively. The 3- and 5-year OS and DFS rates were 60.7%, 39.5% and 28%, 21.5%, respectively. Neither overall postoperative complications nor major and septic complications or CCI had a significant impact on OS or DFS. Multivariate analysis identified the N2 stage as an independent prognostic of poor OS, while N2 stage and four or more SCLMs were independent predictors for poor DFS. Conclusion: N2 stage and four or more SCLMs impacted OS and/or DFS, while CCI, presence, type, or grade of postoperative complications had no significant impact on long-term outcomes.
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Affiliation(s)
- Sorin Tiberiu Alexandrescu
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Surgery, Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Narcis Octavian Zarnescu
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Second Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
- Correspondence: ; Tel.: +40-723-592-483
| | - Andrei Sebastian Diaconescu
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Surgery, Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Dana Tomescu
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- 3rd Department of Anesthesia and Intensive Care, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Gabriela Droc
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- 1st Department of Anesthesia and Intensive Care, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Doina Hrehoret
- Department of Surgery, Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Vladislav Brasoveanu
- Department of Surgery, Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Faculty of Medicine, « Titu Maiorescu » University, 040441 Bucharest, Romania
| | - Irinel Popescu
- Department of Surgery, Center for Digestive Disease and Liver Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Faculty of Medicine, « Titu Maiorescu » University, 040441 Bucharest, Romania
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Kemper M, Heumann A, Freiwald-Bibiza E, Stüben BO, Izbicki JR, Li J. Liver surgery-specific complications are an independent factor influencing long-term survival following major hepatectomy. HPB (Oxford) 2021; 23:1496-1505. [PMID: 33865711 DOI: 10.1016/j.hpb.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/06/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND A severity grading system for liver surgery-specific complications, given the acronym FABIB, has been standardized to increase the feasibility and comparability of academic reports in liver surgery. Whether the FABIB score is associated with long-term survival following major hepatectomy has not been previously investigated. METHODS 297 consecutive patients who had undergone major hepatectomy between 2012 and 2019 were recruited. The postoperative complications were documented according to the FABIB system and, for comparison purposes, Clavien-Dindo classification. Their influence on 90-day mortality and long-term survival was analyzed retrospectively. RESULTS Taking the relevant confounders into account, the FABIB score was a robust factor associated with long-term survival after major hepatectomy: patients with high FABIB scores (≥6) had a 2.415-fold higher risk of death compared to patients with low FABIB scores (≤2) (P = 0.002). In contrast to that, the Clavien-Dindo Classification (grade III + IV vs. grade I + II) was not associated with survival in our cohort (P = 0.873). CONCLUSION Liver surgery-specific complications, measured by the FABIB system, impact long-term survival after major hepatectomy independent of relevant confounders. We propose the FABIB score as a composite endpoint for randomized controlled trials and a quality assessment tool in liver surgery.
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Affiliation(s)
- Marius Kemper
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Germany
| | - Asmus Heumann
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Germany
| | - Eric Freiwald-Bibiza
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Björn-Ole Stüben
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Germany
| | - Jun Li
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Germany.
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Wong LH, Sutton TL, Walker BS, Lopez CD, Kardosh A, Eil RL, Chen EY, Billingsley KG, Mayo SC. Surgical and oncologic outcomes following repeat hepatic resection of colorectal liver metastasis: Who benefits? Am J Surg 2021; 221:1114-1118. [PMID: 33722380 DOI: 10.1016/j.amjsurg.2021.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Resected colorectal liver metastases (CRLM) frequently recur intrahepatically. Selection criteria for repeat hepatectomy of recurrent CRLM are ill-defined. METHODS We performed an institutional review of patients with recurrent CRLM undergoing repeat hepatectomy from 2003 to 19. Post-recurrence overall (rOS) and recurrence-free survival (RFS) were analyzed with Cox proportional hazards modeling. RESULTS n = 147 experienced recurrent CRLM; 11% (n = 38) received repeat hepatectomy of which there was one Clavien-Dindo IIIa complication. Median rOS was 41 months; median RFS was 9 months. Improved rOS and RFS were independently associated with additional post-operative chemotherapy after repeat hepatectomy (HR 0.35 and 0.34, respectively); poor rOS with recurrent CRLM >3 cm (HR 4.4) and <12 months from first hepatectomy to recurrence (HR 4.8); poor RFS with ≥3 recurrence liver metastases (HR 2.8) (All P < 0.05). DISCUSSION Repeat hepatectomy for recurrent CRLM can be performed safely. Worse survival following repeat hepatectomy is independently associated with >3 cm and ≥3 liver lesions at recurrence, and <12 months to recurrence. Additional post-operative chemotherapy after repeat hepatectomy is associated with improved outcomes.
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Affiliation(s)
- Liam H Wong
- Oregon Heath & Science University (OHSU), School of Medicine, Portland, OR, 97239, USA
| | - Thomas L Sutton
- Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; The Knight Cancer Institute at OHSU, Portland, OR, 97239, USA
| | - Brett S Walker
- Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA
| | - Charles D Lopez
- OHSU, Department of Hematology/Oncology, Portland, OR, 97239, USA
| | - Adel Kardosh
- OHSU, Department of Hematology/Oncology, Portland, OR, 97239, USA
| | - Robert L Eil
- Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; The Knight Cancer Institute at OHSU, Portland, OR, 97239, USA
| | - Emerson Y Chen
- OHSU, Department of Hematology/Oncology, Portland, OR, 97239, USA
| | - Kevin G Billingsley
- Smilow Cancer Hospital, Yale New Haven Hospital, New Haven, CT, 06511, USA; Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Skye C Mayo
- Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; The Knight Cancer Institute at OHSU, Portland, OR, 97239, USA.
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Chen Q, Wu C, Zhao H, Wu J, Zhao J, Bi X, Li Z, Huang Z, Zhang Y, Zhou J, Cai J. Neo-adjuvant Chemotherapy-Induced Neutropenia Is Associated with Histological Responses and Outcomes after the Resection of Colorectal Liver Metastases. J Gastrointest Surg 2020; 24:659-670. [PMID: 30937711 DOI: 10.1007/s11605-019-04202-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/07/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Neutropenia, the major adverse event in chemotherapy, is associated with favourable clinical outcome in several solid tumours. We aimed to investigate the predictive value of neo-adjuvant chemotherapy (NAC)-induced neutropenia for the pathological response and prognosis in colorectal liver metastases (CRLM) patients. METHODS A retrospective review was performed in 141 CRLM patients receiving NAC followed by liver resection. A logistic regression was applied to analyse potential predictors. A Cox proportional hazards analysis was used to analyse survival. RESULTS Neutropenia due to NAC was observed in 42.6% (60/141) of all patients, and grade 3/4 neutropenia was noted in 31.7% (19/60). A pathological response (tumour regression grade (TRG) 1-3) was reported in 46.1% (65/141) of patients. Multivariate analysis showed that neutropenia significantly predicted the favourable pathological response (OR = 3.718, 95% CI 1.716-8.329, P = 0.001), as well as targeted therapy, good differentiation and preoperative CEA < 10 ng/ml as independent predictors of favourable histological response. Of the patients, 54.6% (77/141) had postoperative complications, including 28 major complications (28/77, 36.4%). Severe neutropenia significantly predicted postoperative major complications in multivariate analysis (OR = 4.077, 95% CI 1.184-14.038, P = 0.026). Compared to patients without neutropenia, patients with neutropenia had significantly better progression-free survival (PFS) (P = 0.007; mPFS, 10.2 months vs. 6.7 months). Patients with histological response had significantly better PFS than patients with no histological response (P = 0.001; mPFS, 10.0 months vs. 5.5 months). According to multivariate analyses, neutropenia was a significant predictor for better PFS (HR = 0.613, 95% CI 0.406-0.925, P = 0.020) but not OS. CONCLUSIONS For CRLM patients receiving NAC followed by liver resection, NAC-induced neutropenia was a significant predictor of favourable pathological response, postoperative major complications and better prognosis, which makes it useful for CRLM patients in guiding treatment approaches and prognosis assessments.
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Affiliation(s)
- Qichen Chen
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Chaorui Wu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hong Zhao
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jianxiong Wu
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jianjun Zhao
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xinyu Bi
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhiyu Li
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhen Huang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yefan Zhang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jianguo Zhou
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Jianqiang Cai
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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5
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Impact of Postoperative Complications on Survival and Recurrence After Resection of Colorectal Liver Metastases. Ann Surg 2019; 270:1018-1027. [DOI: 10.1097/sla.0000000000003254] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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6
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Brown KM, Albania MF, Samra JS, Kelly PJ, Hugh TJ. Propensity score analysis of non-anatomical versus anatomical resection of colorectal liver metastases. BJS Open 2019; 3:521-531. [PMID: 31388645 PMCID: PMC6677098 DOI: 10.1002/bjs5.50154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/24/2019] [Indexed: 12/14/2022] Open
Abstract
Background There are concerns that non‐anatomical resection (NAR) worsens perioperative and oncological outcomes compared with those following anatomical resection (AR) for colorectal liver metastases (CRLM). Most previous studies have been biased by the effect of tumour size. The aim of this study was to compare oncological outcomes after NAR versus AR. Methods This was a retrospective study of consecutive patients who underwent CRLM resection with curative intent from 1999 to 2016. Data were retrieved from a prospectively developed database. Survival and perioperative outcomes for NAR and AR were compared using propensity score analyses. Results Some 358 patients were included in the study. Median follow‐up was 34 (i.q.r. 16–68) months. NAR was associated with significantly less morbidity compared with AR (31·1 versus 44·4 per cent respectively; P = 0·037). Larger (hazard ratio (HR) for lesions 5 cm or greater 1·81, 95 per cent c.i. 1·13 to 2·90; P = 0·035) or multiple (HR 1·48, 1·03 to 2·12; P = 0·035) metastases were associated with poor overall survival (OS). Synchronous (HR 1·33, 1·01 to 1·77; P = 0·045) and multiple (HR 1·51, 1·14 to 2·00; P = 0·004) liver metastases, major complications after liver resection (HR 1·49, 1·05 to 2·11; P = 0·026) or complications after resection of the primary colorectal tumour (HR 1·51, 1·01 to 2·26; P = 0·045) were associated with poor disease‐free survival (DFS). AR was prognostic for poor OS only in tumours smaller than 30 mm, and R1 margin status was not prognostic for either OS or DFS. NAR was associated with a higher rate of salvage resection than AR following intrahepatic recurrence. Conclusions NAR has at least equivalent oncological outcomes to AR while proving to be safer. NAR should therefore be the primary surgical approach to CRLM, especially for lesions smaller than 30 mm.
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Affiliation(s)
- K M Brown
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards Sydney New South Wales Australia.,Discipline of Surgery, Northern Clinical School, University of Sydney Sydney New South Wales Australia
| | - M F Albania
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards Sydney New South Wales Australia
| | - J S Samra
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards Sydney New South Wales Australia.,Faculty of Medicine and Health Sciences Macquarie University Sydney New South Wales Australia
| | - P J Kelly
- Sydney School of Public Health, University of Sydney Sydney New South Wales Australia
| | - T J Hugh
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards Sydney New South Wales Australia.,Discipline of Surgery, Northern Clinical School, University of Sydney Sydney New South Wales Australia
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7
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Schwarz C, Plass I, Fitschek F, Punzengruber A, Mittlböck M, Kampf S, Asenbaum U, Starlinger P, Stremitzer S, Bodingbauer M, Kaczirek K. The value of indocyanine green clearance assessment to predict postoperative liver dysfunction in patients undergoing liver resection. Sci Rep 2019; 9:8421. [PMID: 31182746 PMCID: PMC6557886 DOI: 10.1038/s41598-019-44815-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/21/2019] [Indexed: 12/27/2022] Open
Abstract
Postoperative liver dysfunction remains a major concern following hepatic resection. In order to identify patients who are at risk of developing liver dysfunction, indocyanine green (ICG) clearance has been proposed to predict postoperative liver function. All patients who underwent liver resection at the Medical University Vienna, Austria between 2006 and 2015 with preoperative ICG clearance testing (PDR, R15) were analyzed in this study. Postoperative liver dysfunction was analyzed as defined by the International Study Group of Liver Surgery. Overall, 698 patients (male: 394 (56.4%); female: 304 (43.6%)) with a mean age of 61.3 years (SD: 12.9) were included in this study, including 313 minor liver resections (44.8%) and 385 major liver resections (55.2%). One hundred and seven patients developed postoperative liver dysfunction after liver resection (15.3%). Factors associated with liver dysfunction were: male sex (p = 0.043), major liver resection (p < 0.0001), and preoperative ICG clearance (PDR (p = 0.002) and R15 (p < 0.0001)). Notably ICG clearance was significantly associated with liver dysfunction in minor and major liver resections respectively and remained a predictor upon multivariable analysis. An optimal cut-off for preoperative ICG clearance to accurately predict liver dysfunction was PDR < 19.5%/min and R15 > 5.6%. To the best of our knowledge, this is the largest study analyzing the predictive value of preoperative ICG clearance assessment in patients undergoing liver resection. ICG clearance is useful to identify patients at risk of postoperative liver dysfunction.
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Affiliation(s)
- Christoph Schwarz
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Immanuel Plass
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Fabian Fitschek
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Antonia Punzengruber
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Martina Mittlböck
- Section for Medical Statistics, Medical University Vienna, Vienna, Austria
| | - Stephanie Kampf
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Ulrika Asenbaum
- Department of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Patrick Starlinger
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Stefan Stremitzer
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Martin Bodingbauer
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Klaus Kaczirek
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria.
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8
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Chen Q, Zhao H, Wu J, Cai J, Li C, Zhao J, Bi X, Li Z, Huang Z, Zhang Y, Cui W, Zhou J. Preoperative D-dimer and Gamma-Glutamyltranspeptidase Predict Major Complications and Survival in Colorectal Liver Metastases Patients After Resection. Transl Oncol 2019; 12:996-1004. [PMID: 31125760 PMCID: PMC6531870 DOI: 10.1016/j.tranon.2019.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES: To investigate the predictive value of the pre-operative D-dimer and gamma-glutamyltranspeptidase (GGT) for the prognosis in colorectal liver metastases (CRLM) patients after hepatic resection. METHODS: Two hundred and ninety-two patients between December 2008 and December 2016 and 101 patients at our center from January 2017 to December 2018 were selected as a training set and validation set, respectively. The combination of the pre-operative D-dimer and GGT status (CPDG score) was scored as follows: elevated D-dimer levels with elevated GGT levels was allocated a score of 2, decreased D-dimer levels with decreased GGT levels was allocated a score of 0, and all other combinations were allocated a score of 1. In the training set, a logistic regression was applied to explore potential predictors of major postoperative complications. A Cox proportional hazards analysis was used to analyze survival. We further verified our findings in the validation set. RESULTS: Major complications occurred in 43 (14.7%) and 25 (24.8%) patients in the training set and validation set, respectively. In the training set, multivariate analysis showed that elevated GGT levels and elevated D-dimer levels independently predicted major complications respectively. In the multivariate analyses, elevated pre-operative D-dimer levels remained independently associated with decreased overall survival (OS) (hazard ratio [HR] = 1.751, 95% confidence interval [CI]: 1.139-2.691, P = .01). The CPDG score was an independent prognostic factor for major complications and OS in the multivariate analyses. The predictive ability of the CPDG score was higher than either factor alone. A Kaplan-Meier survival analysis showed that compared with patients with CPDG score = 1 or CPDG score = 0, patients with a CPDG score = 2 had worsened OS. Furthermore, for OS comparisons, the differences between any two groups were significant. In the validation set, elevated GGT and D-dimer were also suggested to predict worse progression-free survival (PFS) and to be independently associated with major complications. CONCLUSIONS: The pre-operative D-dimer levels, GGT levels and CPDG score are reliable biomarkers to predict post-operative major complications or survival in CRLM patients after hepatic resection, which make it useful for CRLM patients in guiding surveillance approaches and prognosis assessments.
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Affiliation(s)
- Qichen Chen
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Zhao
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianxiong Wu
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianqiang Cai
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cong Li
- Department of colorectal surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jianjun Zhao
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyu Bi
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiyu Li
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhen Huang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yefan Zhang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Cui
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jianguo Zhou
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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9
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Procedure-Specific Volume and Nurse-to-Patient Ratio: Implications for Failure to Rescue Patients Following Liver Surgery. World J Surg 2018; 43:910-919. [PMID: 30465087 DOI: 10.1007/s00268-018-4859-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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10
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McCluney SJ, Giakoustidis A, Segler A, Bissel J, Valente R, Hutchins RR, Abraham AT, Bhattacharya S, Kocher HM. Neutrophil: Lymphocyte ratio as a method of predicting complications following hepatic resection for colorectal liver metastasis. J Surg Oncol 2018; 117:1058-1065. [DOI: 10.1002/jso.24996] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Simon J. McCluney
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
- Barts Cancer Institute-Cancer Research UK Centre of Excellence; Queen Mary UK
| | - Alexandros Giakoustidis
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Angela Segler
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Juliane Bissel
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Roberto Valente
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Robert R. Hutchins
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Ajit T. Abraham
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Satyajit Bhattacharya
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Hemant M. Kocher
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
- Barts Cancer Institute-Cancer Research UK Centre of Excellence; Queen Mary UK
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11
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Brown KM, Xue A, Julovi SM, Gill AJ, Pavlakis N, Samra JS, Smith RC, Hugh TJ. Using patient-derived xenograft models of colorectal liver metastases to predict chemosensitivity. J Surg Res 2018; 227:158-167. [PMID: 29804848 DOI: 10.1016/j.jss.2018.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/23/2018] [Accepted: 02/13/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few in vivo models for colorectal cancer have been demonstrated to show external validity by accurately predicting clinical patient outcomes. Patient-derived xenograft (PDX) models of cancer have characteristics that might provide a form of translational research leading to personalized cancer care. The aim of this pilot study was to assess the feasibility of using PDXs as a platform for predicting patient colorectal liver metastases responses, in this case by correlating PDX and patient tumor responses to either folinic acid, fluorouracil plus oxaliplatin or folinic acid, fluorouracil plus irinotecan-based regimens. METHODS Sixteen patients underwent potentially curative resection of colorectal liver metastases, and tumors were grafted into NOD.CB17-Prkdcscid/Arc mice. Mice were divided into groups to determine relative tumor growth in response to treatment. Tumors were analyzed by immunohistochemistry for Ki67 and Excision repair cross-complementation group 1. RESULTS An engraftment rate of 81% was achieved. Overall, there was a 67% positive match rate between eligible patient and PDX chemosensitivity profiles. There was a significant difference in relative decrease in Ki67 expression between sensitive/stable versus resistant PDXs for both treatment regimens. There was no statistically significant correlation between baseline ERCC1 expression and response to Oxaliplatin + 5-Fluorouracil in the PDXs. CONCLUSIONS This pilot study supports the feasibility of using PDX models of advanced colorectal cancer in larger studies to potentially predict patient chemosensitivity profiles.
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Affiliation(s)
- Kai M Brown
- Cancer Surgery and Metabolism Research Group, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Northern Clinical School, University of Sydney, Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, New South Wales, Australia.
| | - Aiqun Xue
- Cancer Surgery and Metabolism Research Group, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Northern Clinical School, University of Sydney, Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, New South Wales, Australia
| | - Sohel M Julovi
- Cancer Surgery and Metabolism Research Group, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Nick Pavlakis
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Jaswinder S Samra
- Northern Clinical School, University of Sydney, Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, New South Wales, Australia
| | - Ross C Smith
- Cancer Surgery and Metabolism Research Group, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Thomas J Hugh
- Cancer Surgery and Metabolism Research Group, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Northern Clinical School, University of Sydney, Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, New South Wales, Australia
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12
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Buettner S, Ethun CG, Poultsides G, Tran T, Idrees K, Isom CA, Weiss M, Fields RC, Krasnick B, Weber SM, Salem A, Martin RC, Scoggins CR, Shen P, Mogal HD, Schmidt C, Beal E, Hatzaras I, Shenoy R, Koerkamp BG, Maithel SK, Pawlik TM. Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies. J Gastrointest Surg 2017; 21:1813-1820. [PMID: 28913712 PMCID: PMC5905431 DOI: 10.1007/s11605-017-3571-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/29/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical site infections (SSI) are one of the most common complications after hepato-pancreato-biliary surgery. Infectious complications may lead to an associated immune-modulatory effect that inhibits the body's response to cancer surveillance. We sought to define the impact of SSI on long-term prognosis of patients undergoing surgical resection of extrahepatic biliary malignancies (EHBM). METHODS Patients undergoing surgery for EHBM between 2000 and 2014 were identified using a large, multi-center, national cohort dataset. Recurrence free survival (RFS) was calculated and a multivariable Cox proportional hazards model was utilized to identify potential risk factors for RFS including SSI. RESULTS Seven hundred twenty-eight patients included in the analytic cohort; 236 (32.4%) patients had perihilar cholangiocarcinoma, 241 (33.1%) gallbladder cancer, and 251 (34.5%) distal cholangiocarcinoma. A major resection, liver resection, was performed in 205 (28.3%) patients, while 110 (15.2%) patients had a pancreaticoduodenectomy. The overall incidence of morbidity was 55.8%; among the 397 patients who experienced a complication, 161 patients specifically had an SSI. The SSI occurred as an infection of the surgical site (n = 70, 9.6%) or formation of an abscess in the operative bed (n = 91, 12.5%). SSI was associated with long-term survival as patients who experienced an SSI had a median RFS of 19.5 months compared with 30.5 months for those patients who did not have an SSI (HR 1.40, 95% CI 1.08-1.80; p = 0.01). Among 279 patients who had EHBM that had no associated lymph node metastases, well-to-moderate tumor differentiation, as well as an R0 resection margin, SSI remained associated with worse RFS (HR 1.84, 95% CI 1.03-3.29; p = 0.038), as well as overall survival (HR 1.87, 95% CI 1.18-2.97; p = 0.008). CONCLUSION SSI was a relatively common occurrence following surgery for EHBM as 1 in 10 patients experienced an SSI. In addition to standard tumor-specific factors, the occurrence of postoperative SSI was adversely associated with long-term survival.
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Affiliation(s)
- Stefan Buettner
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Cecilia G. Ethun
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Thuy Tran
- Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Kamran Idrees
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Chelsea A. Isom
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew Weiss
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Ryan C. Fields
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Bradley Krasnick
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Sharon M. Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ahmed Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | - Perry Shen
- Department of Surgery, Wake Forest University, Winston-Salem, NC
| | | | - Carl Schmidt
- Department of Surgery, Ohio State University, Columbus, OH
| | - Eliza Beal
- Department of Surgery, Ohio State University, Columbus, OH
| | | | - Rivfka Shenoy
- Department of Surgery, New York University, New York, NY
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
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13
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Gray AD, Petrou G, Rastogi P, Begbie S. Elective hepatic resection is feasible and safe in a regional centre. ANZ J Surg 2016; 88:E147-E151. [PMID: 27862779 DOI: 10.1111/ans.13828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/26/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hepatic resectional surgery remains a highly specialized area of general surgery usually reserved for completion at tertiary metropolitan referral centres. Port Macquarie, on the Mid North Coast of New South Wales, is the only regionally based hospital offering surgery of this nature in mainland Australia. The purpose of this study is to review the data for patients undergoing hepatic resectional surgery in this non-metropolitan centre in order to illustrate that these operations can be carried out safely in a regional setting with comparable results to tertiary-level centres. METHODS A retrospective review of consecutive patients undergoing elective hepatic resections at Port Macquarie from February 2008 to 31 October 2015 was completed. Pre-morbid patient clinical and demographic factors, histopathological details, post-operative complications, survival and mortality data were all noted. RESULTS A total of 66 consecutive elective liver resections were performed during the study period. Metastatic colorectal cancer was the most commonly observed pathology (n = 33, 50.0%). The 90-day mortality was 4.5% (n = 3) whilst 17 patients (n = 17, 25.8%) experienced major complications (Clavien-Dindo grade 3 or 4). The median overall survival following hepatectomy for colorectal metastases was 48 months (95% confidence interval 37-59 months). CONCLUSION Our study shows excellent morbidity, mortality and survival for hepatic resectional surgery performed in a regional centre and is comparable data to major metropolitan centres. Our study confirms that major hepatic resectional surgery in this setting is safe and effective.
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Affiliation(s)
- Andrew D Gray
- Department of General Surgery, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia.,Department of General Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - George Petrou
- Department of General Surgery, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia.,Department of General Surgery, Port Macquarie Private Hospital, Port Macquarie, New South Wales, Australia
| | - Pratik Rastogi
- Department of General Surgery, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Stephen Begbie
- Mid North Coast Cancer Institute, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
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14
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Dekker AM, Wiggers JK, Coelen RJ, van Golen RF, Besselink MG, Busch OR, Verheij J, Hollmann MW, van Gulik TM. Perioperative blood transfusion is not associated with overall survival or time to recurrence after resection of perihilar cholangiocarcinoma. HPB (Oxford) 2016; 18:262-70. [PMID: 27017166 PMCID: PMC4814620 DOI: 10.1016/j.hpb.2015.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 08/31/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Perioperative blood transfusions have been associated with worse oncological outcome in several types of cancer. The objective of this study was to assess the effect of perioperative blood transfusions on time to recurrence and overall survival (OS) in patients who underwent curative-intent resection of perihilar cholangiocarcinoma (PHC). METHODS This retrospective cohort study included consecutive patients with resected PHC between 1992 and 2013 in a specialized center. Patients with 90-day mortality after surgery were excluded. Patients who did and did not receive perioperative blood transfusions were compared using univariable Kaplan-Meier analysis and multivariable Cox regression. RESULTS Of 145 included patients, 80 (55.2%) received perioperative blood transfusions. The median OS was 49 months for patients without and 41 months for patients with blood transfusions (P = 0.46). In risk-adjusted multivariable Cox regression analysis, blood transfusion was not associated with OS (HR 1.00, 95% CI 0.59-1.68, P = 0.99) or time to recurrence (HR 1.00, 95% CI 0.57-1.78, P = 0.99). In addition, no differences in effect were found between different types of blood products transfused. CONCLUSION Blood transfusion was not associated with survival or time to recurrence after curative resection of PHC in this series. The alleged association is presumably related to the circumstances necessitating blood transfusions.
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Affiliation(s)
- Annemiek M. Dekker
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Jimme K. Wiggers
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Robert J. Coelen
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Rowan F. van Golen
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Marc G.H. Besselink
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Olivier R.C. Busch
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Joanne Verheij
- Department of Pathology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Markus W. Hollmann
- Department of Anaesthesiology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Thomas M. van Gulik
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands,Correspondence T.M. van Gulik, AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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