Comparison between Comprehensive Complication Index (CCI) and Clavien-Dindo Classification (CDC) in laparoscopic single-stage treatment for common bile duct stones with concomitant gallstones

Abstract

Background: The optimal surgical resection strategy for colorectal cancer with synchronous liver metastases remains unclear. Length of stay is frequently used as an indicator of clinical effectiveness. However, this inaccurately reflects additional hospital stay for subsequent operations or re-admissions. This study adopts the`90-day cumulative length of stay' as a parameter to compare outcomes following simultaneous or staged resection strategies in this patient cohort. Material and Methods: A retrospective analysis was performed of patients undergoing either simultaneous or staged resections for colorectal cancer with synchronous liver metastases between 2009-2018. Patients undergoing ALPPS procedure were excluded. The post-operative hospital stay and re-admissions in the first 90 days post-op were recorded to define the`90-day cumulative length of stay'. Post-operative complications were also recorded using the Clavien-Dindo Classification to determine complication severity. Results: There were fifty-eight patients with a median age of 66 years (interquartile range (IQR): 56-75). Twentyseven patients underwent staged resections, whilst 31 patients underwent simultaneous resections. Thirty-three patients were male. Median cumulative length of stay was 11 (IQR= 9-16) days for simultaneous resection and 16 (IQR= 13-24) days in staged resections (p=0.002). Complication rates did not differ significantly between the two groups, 77.4% and 66.7% in simultaneous and staged resections respectively (p=0.835). Conclusion:This single-centre cohort study demonstrates a statistically significant benefit for simultaneous resection. 90-day cumulative length of stay is a suitable assessment tool for surgical management that may include sequential operations and possible readmissions for complication management. This has not been assessed previously in the context of synchronous colorectal liver metastases. Larger studies, ideally multi-centre randomised trials including subgroup analysis, are required for determining groups of patients that would derive the greatest benefit.