Introduction of the resection severity index as independent risk factor limiting survival after resection of colorectal liver metastases

Gwiasda, Jill; Schrem, Harald; Kaltenborn, Alexander; Mahlmann, Jan; Mix, Heiko; Lehner, Frank; Kayser, Nicolas; Klempnauer, Jürgen; Kulik, Ulf

doi:10.1016/j.suronc.2017.08.002

Cited by 9 publications

(16 citation statements)

References 28 publications

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“…Some variables have been associated with a beneficial effect on OS, i.e., clear resection margins and the performance of only minor hepatic resections [ 10 ]. Additionally, the resection-severity-index (RSI) was recently introduced by our group as a new independent prognostic factor for survival after liver resection for CLM [ 11 ]. All those factors have usually been analyzed as regards the overall outcome after hepatic surgery for CLM while it remains unclear whether long-term survival of more than 10 years can be predicted with a prognostic model.…”

Section: Introductionmentioning

confidence: 99%

Proposal of Two Prognostic Models for the Prediction of 10-Year Survival after Liver Resection for Colorectal Metastases

et al. 2018

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Background One-third of 5-year survivors after liver resection for colorectal liver metastases (CLM) develop recurrence or tumor-related death. Therefore 10-year survival appears more adequate in defining permanent cure. The aim of this study was to develop prognostic models for the prediction of 10-year survival after liver resection for colorectal liver metastases. Methods N=965 cases of liver resection for CLM were retrospectively analyzed using univariable and multivariable regression analyses. Receiver operating curve analyses were used to assess the sensitivity and specificity of developed prognostic models and their potential clinical usefulness. Results The 10-year survival rate was 15.2%. Age at liver resection, application of chemotherapies of the primary tumor, preoperative Quick's value, hemoglobin level, and grading of the primary colorectal tumor were independent significant predictors for 10-year patient survival. The generated formula to predict 10-year survival based on these preoperative factors displayed an area under the receiver operating curve (AUROC) of 0.716. In regard to perioperative variables, the distance of resection margins and performance of right segmental liver resection were additional independent predictors for 10-year survival. The logit link formula generated with pre- and perioperative variables showed an AUROC of 0.761. Conclusion Both prognostic models are potentially clinically useful (AUROCs >0.700) for the prediction of 10-year survival. External validation is required prior to the introduction of these models in clinical patient counselling.

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Section: Introductionmentioning

confidence: 99%

Proposal of Two Prognostic Models for the Prediction of 10-Year Survival after Liver Resection for Colorectal Metastases

et al. 2018

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“…Prognostic stratification scores for survival after resection of different malignancies, including ICC, have been published in recent years to optimize perioperative decision making [29][30][31][32]. We have recently introduced the RSI, estimating the future functional liver remnant with respect to the preoperative liver function and the expected or actual extent of hepatic surgery, as an independent risk factor for survival after resection of hepatocellular carcinoma and colorectal liver metastases [11,12]. In the current study, we were able to demonstrate the significance of the RSI as an independent risk factor for the onset of severe postoperative complications, as well as postoperative survival for patients undergoing resection of ICC.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, we have introduced the resection severity index (RSI) reflecting the degree of liver function and liver cell damage, as well as the extent of hepatic resection, as an independent risk factor for survival in patients with hepatocellular carcinoma and colorectal liver metastases undergoing surgery [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

Beetz

Weigle

Cammann

et al. 2020

Langenbecks Arch Surg

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Purpose The incidence of intrahepatic cholangiocarcinoma is increasing worldwide. Despite advances in surgical and non-surgical treatment, reported outcomes are still poor and surgical resection remains to be the only chance for long-term survival of affected patients. The identification and validation of prognostic factors and scores, such as the recently introduced resection severity index, for postoperative morbidity and mortality are essential to facilitate optimal therapeutic regimens. Methods This is a retrospective analysis of 269 patients undergoing resection of histologically confirmed intrahepatic cholangiocarcinoma between February 1996 and September 2018 at a tertiary referral center for hepatobiliary surgery. Regression analyses were performed to evaluate potential prognostic factors, including the resection severity index. Results Median postoperative follow-up time was 22.93 (0.10–234.39) months. Severe postoperative complications (≥ Clavien-Dindo grade III) were observed in 94 (34.9%) patients. The body mass index (p = 0.035), the resection severity index (ASAT in U/l divided by Quick in % multiplied by the extent of liver resection graded in points; p = 0.006), additional hilar bile duct resection (p = 0.005), and number of packed red blood cells transfused during operation (p = 0.036) were independent risk factors for the onset of severe postoperative complications. Median Kaplan-Meier survival after resection was 27.63 months. Preoperative leukocytosis (p = 0.003), the resection severity index (p = 0.005), multivisceral resection (p = 0.001), and T stage ≥ 3 (p = 0.013) were identified as independent risk factors for survival. Conclusion Preoperative leukocytosis and the resection severity index are useful variables for preoperative risk stratification since they were identified as significant predictors for postoperative morbidity and mortality, respectively.

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“…All of these patients had received extended liver resections and were relatively old; hence, the occurrence of a bile leak itself appears not to be an independent risk factor for poor outcome. Generally, it is well known that perioperative risk increases gradually with age, highlighting the necessity for careful indication of higher risk procedures in this patient group (37)(38)(39)(40)(41).…”

Section: Discussionmentioning

confidence: 99%

The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications, preoperative chemotherapy, and surgical procedures

Spetzler¹,

Schepers²,

Pinnschmidt³

et al. 2019

Hepatobiliary Surg. Nutr

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Background: Bile leaks are one of the most common complications after liver resection. The International Study Group of Liver Surgery (ISGLS) established a uniform bile leak definition including a severity grading. However, a risk factor assessment according to ISGLS grading as well as the clinical implications has not been studied sufficiently so far. Methods: The incidence and grading of bile leaks according to ISGLS were prospectively documented in 501 consecutive liver resections between July 2012 and December 2016. A multivariate regression analysis was performed for risk factor assessment. Association with other surgical complications, 90-day mortality as well as length of hospital stay (LOS) was studied. Results: The total rate of bile leaks in this cohort was 14.0%: 2.8% grade A, 8.0% grade B, and 3.2% grade C bile leaks were observed. Preoperative chemotherapy or biliary intervention, diagnosis of hilar cholangiocarcinoma, colorectal metastasis, central minor liver resection, major hepatectomy, extended hepatectomy or two-stage hepatectomy, were some of the risk factors leading to bile leaks. The multivariate regression analysis revealed that preoperative chemotherapy, major hepatectomy and biliodigestive reconstruction remained significant independent risk factors for bile leaks. Grade C bile leaks were associated not only with surgical site infection, but also with an increased 90-day mortality and prolonged LOS. Conclusions: The preoperative treatment as well as the surgical procedure had significant influence on the incidence and the severity of bile leaks. Grade C bile leaks were clinically most relevant, and led to significant increased LOS, rate of infection, and mortality.

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Introduction of the resection severity index as independent risk factor limiting survival after resection of colorectal liver metastases

Cited by 9 publications

References 28 publications

Proposal of Two Prognostic Models for the Prediction of 10-Year Survival after Liver Resection for Colorectal Metastases

Proposal of Two Prognostic Models for the Prediction of 10-Year Survival after Liver Resection for Colorectal Metastases

Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications, preoperative chemotherapy, and surgical procedures

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