Hepatic resections and enhanced recovery pathway: An Indian encounter

Joshi, Riddhi; Thomas, Martin; Bansode, Rakhee; Mitra, Abhishek; Chaudhari, Vikram; Desouza, Ashwin; Singh, Vincent; Ambulkar, Reshma; Goel, Mahesh; Shrikhande, Shailesh V.; Agarwal, Vandana

doi:10.1016/j.clnesp.2016.02.078

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“…The rate of serious morbidity was lower in our study than in the MetaSync trial despite similar distribution of colon and rectal cancers and similar distribution and extent of liver metastasis [ 7 ]. Some possible reasons might be younger patients with less comorbid conditions, adherence to enhanced recovery pathways [ 14 ], routine prophylactic diversion of low rectal anastomosis, exclusion of patients with highest risk of complications (extended hepatectomy, two-stage liver resection, inadequate FLR, and uncontrolled comorbidities) and limiting preoperative chemotherapy to three months. The growing acceptance of MIS for liver resections as well as advanced CRCs will further contribute to a reduction in morbidity [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…If the upper limit of the 95% confidence interval (CI) of major complications was over 40%, simultaneous resections were considered unsafe. In a previous institutional audit, 21% of liver resections had serious complications [ 14 ]. Assuming a 30% major morbidity rate with synchronous resections, at least 88 patients would be required to demonstrate the safety threshold with 95% confidence.…”

Section: Methodsmentioning

confidence: 99%

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Simultaneous resection of synchronous colorectal liver metastasis: Feasibility and development of a prediction model

Kazi

Patkar

Patel

et al. 2022

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims: Timing of resection for synchronous colorectal liver metastasis (CRLM) has been debated for decades. The aim of the present study was to assess the feasibility of simultaneous resection of CRLM in terms of major complications and develop a prediction model for safe resections. Methods: A retrospective single-center study of synchronous, resectable CRLM, operated between 2013 and 2021 was conducted. Upper limit of 95% confidence interval (CI) of major complications (≥ grade IIIA) was set at 40% as the safety threshold. Logistic regression was used to determine predictors of morbidity. Prediction model was internally validated by bootstrap estimates, Harrell's C-index, and correlation of predicted and observed estimates. Results: Ninety-two patients were operated. Of them, 41.3% had rectal cancers. Major hepatectomy (≥ 4 segments) was performed for 25 patients (27.2%). Major complications occurred in 20 patients (21.7%, 95% CI: 13.8%-31.5%). Predictors of complications were the presence of comorbidities and major hepatectomy (area under the ROC curve: 0.692). Unacceptable level of morbidity (≥ 40%) was encountered in patients with comorbidities who underwent major hepatectomy. Conclusions: Simultaneous bowel and CRLM resection appear to be safe. However, caution should be exercised when combining major liver resections with bowel resection in patients with comorbid conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%