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

Correa‐Gallego, Camilo; Gönen, Mithat; Fischer, Mary; Grant, Florence; Kemeny, Nancy E.; Arslan‐Carlon, Vittoria; Kingham, T. Peter; DeMatteo, Ronald P.; Fong, Yuman; Allen, Peter J.; D’Angelica, Michael I.; Jarnagin, William R.

doi:10.1245/s10434-013-2975-9

Cited by 55 publications

(62 citation statements)

References 21 publications

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“…Evidence from breast, colorectal and pancreatic cancer has shown that delays in receipt of adjuvant therapy negatively impacts disease-free survival, disease-specific survival and overall survival. [27][28][29][30] Given the importance of systemic therapy in gastric cancer survival, minimizing postoperative morbidity in order to get patients, in a timely manner, to their intended oncologic therapy is paramount. 2,31 We identified RBCT as being associated with increased postoperative morbidity and thus as a potentially modifiable factor that can be addressed to improve gastric cancer outcomes.…”

Section: Discussionmentioning

confidence: 99%

The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

et al. 2016

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Background: Red blood cell transfusions (RBCT) carry risk of transfusion-related immunodulation that may impact postoperative recovery. This study examined the association between perioperative RBCT and short-term postoperative outcomes following gastrectomy for gastric cancer. Methods:Using the American College of Surgeons National Surgical Quality Improvement Program database, we compared outcomes of patients (transfused v. nontransfused) undergoing elective gastrectomy for gastric cancer (2007)(2008)(2009)(2010)(2011)(2012). Outcomes were 30-day major morbidity, mortality and length of stay. The association between perioperative RBCT and outcomes was estimated using modified Poisson, logistic, or negative binomial regression. Results:Of the 3243 patients in the entire cohort, we included 2884 patients with nonmissing data, of whom 535 (18.6%) received RBCT. Overall 30-day major morbidity and mortality were 20% and 3.5%, respectively. After adjustment for baseline and clinical characteristics, RBCT was independently associated with increased 30-day mortality (relative risk [RR] 3.1, 95% confidence interval [CI] 1.9-5.0), major morbidity (RR 1.4, 95% CI 1.2-1.8), length of stay (RR 1.2, 95% CI 1.1-1.2), infections (RR 1.4, 95% CI 1.1-1.6), cardiac complications (RR 1.8, 95% CI 1.0-3.2) and respiratory failure (RR 2.3, 95% CI 1.6-3.3). Conclusion:Red blood cell transfusions are associated with worse postoperative short-term outcomes in patients with gastric cancer. Blood management strategies are needed to reduce the use of RBCT after gastrectomy for gastric cancer.Contexte : Les transfusion de globules rouges (TGR) entrainent une immunosuppression qui peut entraver la récupération post-opératoire. Cette étude évalue l'association entre les TGR péri-opératoires et l'issue post-opératoire après gastrectomie pour cancer gastrique (CG). Conclusion :Les TGR sont associées à une détérioration de l'issue post-opératoire après gastrectomie pour CG, dont la morbidité majeure, la mortalité, et la durée d'hospitalisation. Des stratégies multidisciplinaires de gestion du risque transfusionnel sont nécessaires afin de limiter l'utilisation des TGRs après gastrectomie pour CG.

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Section: Discussionmentioning

confidence: 99%

The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

et al. 2016

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“…3 Allogenic blood transfusions may impair normal immune modulatory functions that further contribute to negative outcomes. [33][34][35][36][37] As a result, oncologic outcomes also may be compromised by receipt of blood transfusions due to alterations of host immunity. 13,33,36,37 A study from the National Cancer Institute demonstrated that each additional unit of blood transfused in the perioperative period increased the risk of disease recurrence by 5% and death by 7% in patients undergoing partial hepatectomy for colorectal liver metastases.…”

Section: Discussionmentioning

confidence: 99%

Preoperative anemia is associated with increased use of hospital resources in patients undergoing elective hepatectomy

Tee

Shubert

Ubl

et al. 2015

Surgery

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“…[9-12] Furthermore, postoperative morbidity has been linked with worse long term oncologic outcomes in patients undergoing resection for cancer, which remains the most common indication for liver resection. [13-17] While operative and patient specific factors are related to postoperative morbidity, there are few modifiable factors associated with the development of postoperative morbidity in these patients.…”

Section: Introductionmentioning

confidence: 99%

Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial

Correa‐Gallego

Tan

Arslan‐Carlon

et al. 2015

Journal of the American College of Surgeons

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Background The optimal perioperative fluid resuscitation strategy for liver resections (LR) remains undefined. Goal-directed therapy (GDT) embodies a number of physiologic strategies to achieve an ideal fluid balance and avoid the consequences of over- or under-resuscitation. Study Design In a prospective randomized trial, patients undergoing LR were randomized to GDT using stroke volume variation (SVV) as an endpoint or standard perioperative resuscitation (STD). Primary outcome measure was 30-day morbidity. Results Between 2012 and 2014, 135 patients were randomized (GDT: 69 – STD: 66). Median age was 57yrs, and 56% were male. Metastatic disease comprised 81% of patients. Overall (35% GDT vs 36% STD, p=0.86) and Grade 3 morbidity (28% GDT vs 18% STD, p=0.22) were equivalent. Patients in the GDT arm received less intraoperative fluid (mean 2.0 L GDT vs 2.9 L STD, p<0.001). Perioperative transfusions were required in 4% (6% GDT vs 2% STD, p=0.37) and boluses in the postanesthesia care unit (PACU) were administered to 24% (29% GDT vs 20% STD, p=0.23). Mortality rate was 1% (2/135 patients; both in GDT). On multivariable analysis, male gender, age, combined procedures, higher intraoperative fluid volume, and fluid boluses in PACU were associated with higher 30-day morbidity. Conclusions SVV-guided GDT is safe in patients undergoing LR and led to less intraoperative fluid. While the incidence of postoperative complications was similar in both arms, lower intraoperative resuscitation volume was independently associated with decreased postoperative morbidity in the entire cohort. Future studies should target extensive resections and identify patients receiving large resuscitation volumes, as this population is more likely to benefit from this technique.

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

Abstract: 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.

Cited by 55 publications

References 21 publications

The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

Preoperative anemia is associated with increased use of hospital resources in patients undergoing elective hepatectomy

Goal-Directed Fluid Therapy Using Stroke Volume Variation for Resuscitation after Low Central Venous Pressure-Assisted Liver Resection: A Randomized Clinical Trial

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