Effect of perioperative complications on recurrence and survival after resection of hepatic colorectal metastases: Analysis of data from a randomized controlled trial.

Abstract

3620 Background: Perioperative outcomes such as blood loss, transfusions and morbidity have been associated with cancer specific survival, but this is unsupported by prospective data. Methods: Patients were derived from a previously reported prospective randomized trial of acute normovolemic hemodilution (ANH) versus standard management during major hepatectomy. Patients with metastatic colorectal cancer (mCRC) were selected for analysis. Chemotherapy and survival data were obtained from the medical record. Disease extent was measured using a clinical risk scoring (CRS) system. Log-rank test and Cox proportional hazard model were used to evaluate recurrence free (RFS) and overall survival (OS). Results: This trial enrolled 130 patients, 90 of whom had mCRC. Median follow up was 54 m; median age was 53 yr; 56% were men. The CRS was ≥3 in 55% of patients, and 57% had additional extrahepatic procedures. Morbidity and mortality were 33% and 3%. Chemotherapy was split before and after surgery in 70%; 10% received only preoperative and 19% only postoperative treatment, which was initiated after a median time of 6 wks (IQR = 4-7). RFS and OS were 29 and 59 m. On multivariate analysis, (+) resection margin, high CRS and perioperative complications predicted shorter RFS and OS. Delayed initiation of postoperative chemotherapy (≥ 8 wks) while most common in patients with complications (37 vs 12%; p: 0.01), was not a significant predictor of shorter RFS or OS. Randomization (ANH vs standard) was also not significant in this regard. (See Table.) Conclusions: In this prospective randomized cohort, perioperative morbidity was a highly significant independent predictor of cancer specific outcome, associated with but not entirely explained by delayed initiation of chemotherapy. [Table: see text]