Correlation Between Postoperative Infective Complications and Long-Term Outcomes After Hepatic Resection for Colorectal Liver Metastasis

Farid, Shahid; Aldouri, Amer; Morris‐Stiff, Gareth; Khan, Aamir Z.; Toogood, Giles J.; Lodge, J. Peter A.; Prasad, Kondapalli Siva

doi:10.1097/sla.0b013e3181bfda3c

Cited by 195 publications

(167 citation statements)

References 39 publications

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“…Data concerning the impact of postoperative complications on RFS and OS are somewhat conflicted. 18,25,27,30 Some studies have failed to find an association between perioperative morbidity and oncologic outcomes, 28,31 whereas other studies have noted a detrimental effect of complications on long-term prognosis. 25,32 Our group previously investigated whether postoperative complications were independently associated with shorter RFS and OS in a contemporary cohort of patients undergoing surgery for colorectal liver metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…In general, the incidence of complications and postoperative liver insufficiency reported herein was slightly higher compared with data regarding perioperative outcomes reported for liver resection for other indications. 18,27,28 The higher incidence of mortality and morbidity may, in part, be related to patients with ICC presenting with large, advanced disease requiring more complicated, major surgical procedures. Data concerning the impact of postoperative complications on RFS and OS are somewhat conflicted.…”

Section: Discussionmentioning

confidence: 99%

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Impact of complications on long‐term survival after resection of intrahepatic cholangiocarcinoma

Spolverato

Yakoob

Kim

et al. 2015

Cancer

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BACKGROUND:The impact of postoperative complications on the long-term outcomes of patients undergoing surgery for cancer is unclear. The objective of the current study was to define the incidence of complications among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC) and identify the association between morbidity and long-term outcomes. METHODS: A total of 583 patients undergoing surgery with curative intent for ICC between 1990 and 2013 at 1 of 12 participating institutions were identified. The association between the occurrence and severity of postoperative complications on long-term survival was analyzed. RESULTS: The median age of the patients was 59.9 years and the majority of patients were male (52.3%). A total of 91 patients (15.6%) and 153 patients (26.2%) developed a major and minor postoperative complication, respectively; 18 patients (3.5%) died within 90 days of surgery. Median, 1-year, 3-year, and 5-year recurrence-free survival were 10.0 months, 43.3%, 16.7%, and 11.1%, respectively. Postoperative complications (hazard ratio [HR] CONCLUSIONS: Postoperative complications were found to be independent predictors of worse long-term outcomes. The prevention and management of postoperative complications is crucial to increase both short-term and long-term survival. Cancer 2015;121:2730-9.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of complications on long‐term survival after resection of intrahepatic cholangiocarcinoma

Spolverato

Yakoob

Kim

et al. 2015

Cancer

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“…As evidence grows implicating post-operative complications, in particular infection, in poorer disease-free survival, an important aim must be to pro-actively attempt to minimise infections, and when present to identify and implement treatment in an expedient manner [75] . Risk factors known to be associated with infection include: obesity; major resections requiring blood transfusions; presence of co-morbidities (diabetes, chronic obstructive pulmonary disease); and post-operative bile leaks [88] .…”

Section: Post-operative Sepsismentioning

confidence: 99%

“…Risk factors for complications include: age > 65 years; ASA score ≥ 3; larger extent of resection (multiple tumours, bilobar disease); requirement for blood transfusion; and involved resection margins [75] . Up to 30% can suffer "major" complications; specifically bleeding, liver/ kidney/respiratory failure and sepsis and account for the majority of deaths post surgery [75] . In an attempt to allow comparison across series, the Clavien-Dindo classification of post-operative complication is now frequently reported [76] .…”

Section: Recognising Post-operative Complicationsmentioning

confidence: 99%

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

Farid

Prasad²,

Morris‐Stiff³

2013

WJGS

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Outcomes in hepatic resectional surgery (HRS) have improved as a result of advances in the understanding of hepatic anatomy, improved surgical techniques, and enhanced peri-operative management. Patients are generally cared for in specialist higher-level ward settings with multidisciplinary input during the initial post-operative period, however, greater acceptance and understanding of HRS has meant that care is transferred, usually after 24-48 h, to a standard ward environment. Surgical trainees will be presented with such patients either electively as part of a hepatobiliary firm or whilst covering the service on-call, and it is therefore important to acknowledge the key points in managing HRS patients. Understanding the applied anatomy of the liver is the key to determining the extent of resection to be undertaken. Increasingly, enhanced patient pathways exist in the post-operative setting requiring focus on the delivery of high quality analgesia, careful fluid balance, nutrition and thromboprophlaxis. Complications can occur including liver, renal and respiratory failure, hemorrhage, and sepsis, all of which require prompt recognition and management. We provide an overview of the relevant terminology applied to hepatic surgery, an approach to the post-operative management, and an aid to developing an awareness of complications so as to facilitate better confidence in this complex subgroup of general surgical patients. Core tip: Applied anatomy as used in hepatic surgery is different to the traditional morphological teaching. Applied hepatic anatomy is complex but trainees require an understanding of the basic principles to allow an appreciation of the operations performed. Complications require a low threshold of suspicion as they often have important consequences in relation to patient outcome. Recognition of such with rapid alerting of senior staff can facilitate timely and effective management. To date, no universal protocol exists for management of the post-operative period and varies from centre to centre. We provide a practical overview of the terminology, post-operative management, and complications associated with hepatic surgery.

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“…Failure to deliver timely adjuvant chemotherapy is clearly linked to the onset of perioperative complications, and the potential causal influence of complications on longterm oncological survival has evolved into an independent area of research. [25][26][27][28][29][30][31][32][33][34][35][36][37] Three fascinating studies by Tevis and colleagues, Tzeng and colleagues, and Jin and colleagues in the U.S. Gastric Cancer Collaborative appear to indicate that eventual delivery of chemotherapy largely overcomes the negative prognostic impact of postoperative complications for patients with rectal, pancreatic, and gastric cancer. [38][39][40] In this issue of the Annals of Surgical Oncology, Greenleaf and colleagues tackle this tricky question as it relates to gastric cancer.…”

mentioning

confidence: 99%

Adjuvant Chemotherapy: What’s the Rush?

Cho

2016

Ann Surg Oncol

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Correlation Between Postoperative Infective Complications and Long-Term Outcomes After Hepatic Resection for Colorectal Liver Metastasis

Cited by 195 publications

References 39 publications

Impact of complications on long‐term survival after resection of intrahepatic cholangiocarcinoma

Impact of complications on long‐term survival after resection of intrahepatic cholangiocarcinoma

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

Adjuvant Chemotherapy: What’s the Rush?

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