Abstract
BackgroundFor colorectal liver metastases, surgery is a high-risk procedure due to perioperative morbidity. The objective was to assess severity of complications after fast-track liver surgery for colorectal liver metastases and their impact on morbidity and mortality.MethodsAll patients were treated according to the same fast-track programme. Complications were graded according to the Clavien–Dindo classification for patients undergoing surgery from 2013 to 2015. Correlation between complications and length of stay was analysed by multivariate linear regression.Results564 patient cases were included of which three patients died within 3 months (0.53%, 95% CI: 0.17–1.64%). Complications were common with Grade ≤ 2 in 167 patients (30%) and ≥ Grade 3a in 93 (16%). Patients without complications had a mean length of stay of 4.1 days, which increased with complications: 1.4 days (95% CI: 1.3–1.5) for Grade 2, 1.7 days (1.5–2.0) for Grade 3a, 2.3 days (1.7–3.0) for Grade 3b, 2.6 days (1.6–4.2) for Grade 4a, and 2.9 days (2.8–3.1) for Grade 4b. Following were associated with increased length of stay: complication severity grade, liver insufficiency, ascites, biliary, cardiopulmonary, and infectious complications.ConclusionsComplications after liver surgery for colorectal liver metastases, in a fast track setting, were associated with low mortality, and even severe complications only prolonged length of stay to a minor degree.
Highlights
For colorectal liver metastases, surgery is a high-risk procedure due to perioperative morbidity
Three or more liver resections was nonsignificant, neither was comorbidities evaluated by the American Society of Anaesthesiologists (ASA) score, preoperative bilirubin, or Alanine transaminase (ALAT)
Impact on length of hospital stay Patients without any complications had a mean length of stay of 4.1 days, which increased with complications: 1.4 days for Grade 2, 1.7 days for Grade 3a, 2.3 days for Grade 3b, 2.6 days for Grade 4a, and 2.9 days for Grade 4b
Summary
Surgery is a high-risk procedure due to perioperative morbidity. The objective was to assess severity of complications after fast-track liver surgery for colorectal liver metastases and their impact on morbidity and mortality. The surgical approach to colorectal liver metastases (CRLM) has become increasingly aggressive, resulting in more patients becoming candidates for resection, without hampering the survival rate [1,2,3,4]. Hospital stay and costs implementation of enhanced recovery after surgery is a vital multimodal approach [26]. Complications in patients undergoing resection for CRLM have yet to be described sufficiently, according to type, incidence, severity, risk factors, impact on survival, and length of hospital stay. Patients resected for CRLM may differ from patients undergoing liver resection for other tumours, with respect to type of resection, chemotherapy, and comorbidity
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