Population level outcomes and costs of single stage colon and liver resection versus conventional two-stage approach for the resection of metastatic colorectal cancer

Idrees, Jay J.; Bagante, Fabio; Gani, Faiz; Rosinski, Brad F.; Chen, Qinyu; Merath, Katiuscha; Dillhoff, Mary; Cloyd, Jordan M.; Pawlik, Timothy M.

doi:10.1016/j.hpb.2018.08.007

Cited by 18 publications

(14 citation statements)

References 21 publications

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“…This is within the numbers reported from hepatobiliary centers all over Germany [57]. While the analysis of major resections for CRLM showed 90-day mortality rates between 2% and 8% [63][64][65][66], 90-day mortality rates for perihilar cholangiocarcinoma of up to 14.0% [67] and up to 18% for HCCs have been reported [69]. Furthermore, plain major resections such as hemi-hepatectomies show a better outcome than extended liver resections [30,65].…”

Section: Discussionsupporting

confidence: 66%

Influence of diabetes on short-term outcome after major hepatectomy – an underestimated risk?

Fischer

Fuchs

Stravodimos

et al. 2020

Preprint

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Background: Patient-related risk factors such as diabetes mellitus and obesity are increasing in western countries. At the same time the indications for liver resection in both benign and malignant diseases have been significantly extended in recent years. Major liver resection is performed more frequently in a patient population of old age, comorbidity and high rates of neoadjuvant chemotherapy. The aim of this study was to evaluate whether diabetes mellitus, obesity and overweight are risk factors for the short-term post-operative outcome after major liver resection.Methods: Four hundred seventeen major liver resections (≥3 segments) were selected from a prospective database. Exclusion criteria were prior liver resection in patient’s history and synchronous major intra-abdominal procedures. Overweight was defined as BMI ≥ 25 kg/m² and < 30 kg/m² and obesity as BMI ≥ 30 kg/m². Primary end point was 90-day mortality and logistic regression was used for multivariate analysis. Secondary end points included morbidity, complications according to Clavien-Dindo classification, unplanned readmission, bile leakage, and liver failure. Morbidity was defined as occurrence of a post-operative complication during hospital stay or within 90 days postoperatively.Results: Fifty-nine patients had diabetes mellitus (14.1%), 48 were obese (11.6%) and 147 were overweight (35.5%). There were no statistically significant differences in mortality rates between the groups. In the multivariate analysis, diabetes was an independent predictor of morbidity (OR = 2.44, p = 0.02), Clavien-Dindo grade IV complications (OR = 3.6, p = 0.004), unplanned readmission (OR = 2.44, p = 0.04) and bile leakage (OR = 2.06, p = 0.046). Obese and overweight patients did not have an impaired post-operative outcome compared patients with normal weight. Conclusions: Diabetes has direct influence on the short-term postoperative outcome with an increased risk of morbidity but not mortality. Preoperative identification of high-risk patients will potentially decrease complication rates and allow for individual patient counseling as part of a shared decision-making process. For obese and overweight patients, major liver resection is a safe procedure.

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Section: Discussionsupporting

confidence: 66%

Influence of diabetes on short-term outcome after major hepatectomy – an underestimated risk?

Fischer

Fuchs

Stravodimos

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…This is within the numbers reported from hepatobiliary centers all over Germany [57]. While the analysis of major resections for CRLM showed 90-day mortality rates between 2 and 8% [60][61][62][63], 90-day mortality rates for perihilar cholangiocarcinoma of up to 14% [64] and up to 18% for HCCs have been reported [65]. Furthermore, plain major resections such as hemi-hepatectomies show a better outcome than extended liver resections [35,62,66].…”

Section: Discussionsupporting

confidence: 64%

Influence of diabetes on short-term outcome after major hepatectomy: an underestimated risk?

et al. 2020

View full text Add to dashboard Cite

Background Patient-related risk factors such as diabetes mellitus and obesity are increasing in western countries. At the same time the indications for liver resection in both benign and malignant diseases have been significantly extended in recent years. Major liver resection is performed more frequently in a patient population of old age, comorbidity and high rates of neoadjuvant chemotherapy. The aim of this study was to evaluate whether diabetes mellitus, obesity and overweight are risk factors for the short-term post-operative outcome after major liver resection. Methods Four hundred seventeen major liver resections (≥ 3 segments) were selected from a prospective database. Exclusion criteria were prior liver resection in patient’s history and synchronous major intra-abdominal procedures. Overweight was defined as BMI ≥ 25 kg/m2 and < 30 kg/m2 and obesity as BMI ≥ 30 kg/m2. Primary end point was 90-day mortality and logistic regression was used for multivariate analysis. Secondary end points included morbidity, complications according to Clavien–Dindo classification, unplanned readmission, bile leakage, and liver failure. Morbidity was defined as occurrence of a post-operative complication during hospital stay or within 90 days postoperatively. Results Fifty-nine patients had diabetes mellitus (14.1%), 48 were obese (11.6%) and 147 were overweight (35.5%). There were no statistically significant differences in mortality rates between the groups. In the multivariate analysis, diabetes was an independent predictor of morbidity (OR = 2.44, p = 0.02), Clavien–Dindo grade IV complications (OR = 3.6, p = 0.004), unplanned readmission (OR = 2.44, p = 0.04) and bile leakage (OR = 2.06, p = 0.046). Obese and overweight patients did not have an impaired post-operative outcome compared patients with normal weight. Conclusions Diabetes has direct influence on the short-term postoperative outcome with an increased risk of morbidity but not mortality. Preoperative identification of high-risk patients will potentially decrease complication rates and allow for individual patient counseling as part of a shared decision-making process. For obese and overweight patients, major liver resection is a safe procedure.

show abstract

“…This is within the numbers reported from hepatobiliary centers all over Germany [57]. While the analysis of major resections for CRLM showed 90day mortality rates between 2% and 8% [63][64][65][66], 90-day mortality rates for perihilar cholangiocarcinoma of up to 14% [67] and up to 18% for HCCs have been reported [69]. Furthermore, plain major resections such as hemi-hepatectomies show a better outcome than extended liver resections [30,60,65].…”

Section: Discussionsupporting

confidence: 64%

Influence of diabetes on short-term outcome after major hepatectomy – an underestimated risk?

Fischer

Fuchs

Stravodimos

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundPatient-related risk factors such as diabetes mellitus and obesity are increasing in western countries. At the same time the indications for liver resection in both benign and malignant diseases have been significantly extended in recent years. Major liver resection is performed more frequently in a patient population of old age, comorbidity and high rates of neoadjuvant chemotherapy. The aim of this study was to evaluate whether diabetes mellitus, obesity and overweight are risk factors for the short-term post-operative outcome after major liver resection.MethodsFour hundred seventeen major liver resections (≥3 segments) were selected from a prospective database. Exclusion criteria were prior liver resection in patient’s history and synchronous major intra-abdominal procedures. Overweight was defined as BMI ≥ 25 kg/m 2 and < 30 kg/m 2 and obesity as BMI ≥ 30 kg/m 2 . Primary end point was 90-day mortality and logistic regression was used for multivariate analysis. Secondary end points included morbidity, complications according to Clavien-Dindo classification, unplanned readmission, bile leakage, and liver failure. Morbidity was defined as occurrence of a post-operative complication during hospital stay or within 90 days postoperatively.ResultsFifty-nine patients had diabetes mellitus (14.1%), 48 were obese (11.6%) and 147 were overweight (35.5%). There were no statistically significant differences in mortality rates between the groups. In the multivariate analysis, diabetes was an independent predictor of morbidity (OR = 2.44, p = 0.02), Clavien-Dindo grade IV complications (OR = 3.6, p = 0.004), unplanned readmission (OR = 2.44, p = 0.04) and bile leakage (OR = 2.06, p = 0.046). Obese and overweight patients did not have an impaired post-operative outcome compared patients with normal weight.ConclusionsDiabetes has direct influence on the short-term postoperative outcome with an increased risk of morbidity but not mortality. Preoperative identification of high-risk patients will potentially decrease complication rates and allow for individual patient counseling as part of a shared decision-making process. For obese and overweight patients, major liver resection is a safe procedure.

show abstract

Population level outcomes and costs of single stage colon and liver resection versus conventional two-stage approach for the resection of metastatic colorectal cancer

Cited by 18 publications

References 21 publications

Influence of diabetes on short-term outcome after major hepatectomy – an underestimated risk?

Influence of diabetes on short-term outcome after major hepatectomy – an underestimated risk?

Influence of diabetes on short-term outcome after major hepatectomy: an underestimated risk?

Influence of diabetes on short-term outcome after major hepatectomy – an underestimated risk?

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