ADVERSE OUTCOMES ASSOCIATED WITH COMBINED LIVER AND RECTAL RESECTIONS FOR SYNCHRONOUS RECTAL ADENOCARCINOMA AND HEPATIC METASTASIS
Konstantinos A. Zorbas*1, Vic Velanovich2, Andreas Karachristos2
1BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York, NY; 2University of South Florida, Morsani College of Medicine, Tampa, FL
Introduction
Colorectal cancer (CRC) constitutes the third most common cancer worldwide. 14-18% of CRC patients present with synchronous colorectal metastasis. The most common solid organ metastasis is the liver. The current National Comprehensive Cancer Network Guidelines recommend metastatectomy when possible. However, the simultaneous resection of the primary rectal tumor and liver metastasis is technically challenging and currently there is no consensus regarding staged or combined resection as the best approach. Our primary goal was to examine the postoperative outcomes between combined rectal and liver resections versus isolated resections.
Methods
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried for patients who underwent either rectal resection for cancer or liver resection for colorectal metastasis or simultaneous rectal and liver resection from 2014-2017. The preoperative characteristics of the three groups were evaluated to identify significant preoperative differences. Thirty-day mortality and severe postoperative complications were compared between the three groups. The categorical data were analyzed with chi-square test. Both ANOVA and non-parametric tests were used for the analysis of continue variables.
Results
A total of 19984 patients were identified who met the inclusion criteria. Patients with simultaneous resection were younger compared with the other two groups (57 vs 59 vs 62, p<0.001) and with higher rates of female gender compared to patients with rectal malignancies (43.8% vs 39.6%, p<0.001). Otherwise, the three groups were similar in terms of the other preoperative characteristics. There was no statistically significant difference between the three groups in terms of failure to rescue (Table). However, patients who underwent simultaneous resection had higher rates of organ space surgical site infections, serious complications, overall morbidity, readmission and extended hospital stay.
Conclusion
In conclusion, synchronous resection of rectal cancer and liver metastasis does not result in higher mortality. However, the combined procedure increases organ space SSI, serious complications, overall morbidity, readmission and length of stay. Surgeons should approach combined rectal and liver resections with caution.
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