Ward William H, Hui Jane, Davis Catherine H, Li Tianyu, Goel Neha, Handorf Elizabeth, Ross Eric A, Curley Steven A, Karachristos Andreas, Esnaola Nestor F
Department of Surgery, Naval Medical Center, Portsmouth, VA.
Department of Surgery, University of Minnesota, Minneapolis, MN.
Ann Surg Open. 2021 Mar 11;2(1):e050. doi: 10.1097/AS9.0000000000000050. eCollection 2021 Mar.
Our objective was to compare outcomes following combined versus isolated resections for metastatic colorectal cancer and/or liver metastases using a large, contemporary national database.
Controversy persists regarding optimal timing of resections in patients with synchronous colorectal liver metastases.
We analyzed 11,814 patients with disseminated colorectal cancer and/or liver metastases who underwent isolated colon, rectal, or liver resections (CRs, RRs, or LRs) or combined colon/liver or rectal/liver resections (CCLRs or CRLRs) in the National Surgical Quality Improvement Program Participant Use File (2011-2015). We examined associations between resection type and outcomes using univariate/multivariate analyses and used propensity adjustment to account for nonrandom receipt of isolated versus combined resections.
Two thousand four hundred thirty-seven (20.6%); 2108 (17.8%); and 6243 (52.8%) patients underwent isolated CR, RR, or LR; 557 (4.7%) and 469 (4.0%) underwent CCLR or CRLR. Three thousand three hundred ninety-five patients (28.7%) had serious complications (SCs). One hundred forty patients (1.2%) died, of which 113 (80.7%) were failure to rescue (FTR). One thousand three hundred eighty-six (11.7%) patients experienced unplanned readmission. After propensity adjustment and controlling for procedural complexity, wound class, and operation year, CCLR/CRLR was independently associated with increased risk of SC, as well as readmission (compared with LR). CCLR was also independently associated with increased risk of FTR and death (compared with LR).
Combined resection uniformly confers increased risk of SC and increased risk of mortality after CCLR; addition of colorectal to LR increases risk of readmission. Combined resections are less safe, and potentially more costly, than isolated resections. Effective strategies to prevent SC after combined resections are warranted.
我们的目标是使用一个大型的当代国家数据库，比较转移性结直肠癌和/或肝转移患者联合切除与单独切除后的结局。
对于同时性结直肠癌肝转移患者的最佳切除时机仍存在争议。
我们分析了国家外科质量改进计划参与者使用文件（2011 - 2015年）中11814例患有播散性结直肠癌和/或肝转移的患者，这些患者接受了单独的结肠、直肠或肝切除（CRs、RRs或LRs）或联合结肠/肝或直肠/肝切除（CCLRs或CRLRs）。我们使用单变量/多变量分析检查切除类型与结局之间的关联，并使用倾向调整来解释单独切除与联合切除的非随机接受情况。
2437例（20.6%）；2108例（17.8%）；6243例（52.8%）患者接受了单独的CR、RR或LR；557例（4.7%）和469例（4.0%）接受了CCLR或CRLR。3395例患者（28.7%）发生了严重并发症（SCs）。140例患者（1.2%）死亡，其中113例（80.7%）是抢救失败（FTR）。1386例（11.7%）患者经历了意外再入院。在倾向调整并控制手术复杂性、伤口类别和手术年份后，CCLR/CRLR与SC风险增加以及再入院独立相关（与LR相比）。CCLR也与FTR和死亡风险增加独立相关（与LR相比）。
联合切除一致地赋予CCLR后SC风险增加和死亡风险增加；在LR基础上增加结肠切除会增加再入院风险。联合切除比单独切除安全性更低，且可能成本更高。有必要采取有效的策略来预防联合切除后的SC。
