Perioperative complications influence recurrence and survival after resection of hepatic colorectal metastases

Abstract

Perioperative outcomes, such as blood loss, transfusions, and morbidity, have been linked to cancer-specific survival, but this is largely unsupported by prospective data. Patients from a previous, randomized trial that evaluated acute normovolemic hemodilution during major hepatectomy (≥3 segments) were reevaluated and those with metastatic colorectal cancer (n=90) were selected for analysis. Survival data were obtained from the medical record. Disease extent was measured using a clinical-risk score (CRS). Log-rank test and Cox proportional hazard model were used to evaluate recurrence-free survival (RFS) and overall survival (OS). Median follow-up was 71months. The CRS was ≥3 in 45% of patients; 59% had extrahepatic procedures. Morbidity and mortality were 33 and 2%, respectively. Postoperative chemotherapy was given to 87% of patients (78/90) starting at a median of 6weeks. RFS and OS were 29 and 60months, respectively. Postoperative morbidity significantly reduced RFS (23 vs. 69months; P<0.001) and OS (28 vs. 74months; P<0.001) on uni- and multi-variate analysis; positive resection margins and high CRS also were significant factors. Delayed initiation of postoperative chemotherapy (≥8weeks) was common in patients with complications (37 vs. 12%; P=0.01). In this selected cohort of patients from a previous RCT, perioperative morbidity was strongly (and independently) associated with cancer-specific outcome. It also was associated with delayed initiation of postoperative chemotherapy, the impact of which on survival is unclear.