Impact of Synchronous Liver Resection on the Perioperative Outcomes of Patients Undergoing CRS-HIPEC

J Gastrointest Surg. 2018 Sep;22(9):1576-1584. doi: 10.1007/s11605-018-3784-z. Epub 2018 Apr 30.

Abstract

Background: While liver resection (LR) and cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) are commonly performed for hepatic and peritoneal metastases, respectively, the safety of synchronous LR and CRS-HIPEC has not been established.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) databases from 2005 to 2016 were used to identify patients who underwent CRS-HIPEC. Demographic, clinical, and perioperative outcomes were compared among patients who underwent CRS-HIPEC with and without synchronous LR.

Results: Among 1168 patients who underwent CRS-HIPEC, 100 (8.6%) underwent synchronous LR and 1068 (91.4%) did not. The most common primary diagnosis was unspecified (65.3%) followed by appendix (16.0%) and colorectal (12.5%). Among patients who underwent CRS-HIPEC plus LR, the majority had a partial hepatectomy (96.0%), while a small subset underwent trisegmentectomy (2.0%) or hemihepatectomy (2.0%). Patients who underwent CRS-HIPEC plus LR underwent a greater number of operative procedures (8.3 ± 2.5 vs 6.7 ± 2.5, p < 0.001), had a longer operative time (520.7 ± 155.3 vs 454.6 ± 160.7 min, p = 0.001), had a longer hospital length of stay (16.7 ± 15.6 vs 11.1 ± 11.5 days, p < 0.001), were more likely to require reoperation (13.0 vs 6.9%, p = 0.03), and experienced greater 30-day morbidity (47.0 vs 27.4%, p < 0.001), but not mortality (3.0 vs 1.4%, p = 0.22). On multivariate logistic regression, LR was strongly associated with increased risk of postoperative morbidity even after controlling for potential confounders (OR 1.65, 95% CI 1.03-2.64).

Conclusions: Simultaneous LR and CRS-HIPEC was associated with increased operative time, length of hospital stay, reoperation, and postoperative morbidity compared to CRS-HIPEC alone. For patients with synchronous hepatic and peritoneal metastases, a staged operative approach should be considered.

Keywords: Appendiceal cancer; Carcinomatosis; Colorectal cancer; Cytoreductive surgery; Hepatectomy; Hyperthermic intraperitoneal chemotherapy.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures* / adverse effects
  • Female
  • Hepatectomy* / adverse effects
  • Hepatectomy* / methods
  • Humans
  • Hyperthermia, Induced*
  • Length of Stay
  • Liver Neoplasms / secondary
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Operative Time
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Postoperative Complications / etiology
  • Reoperation