Volume 115, Issue 3 pp. 337-343

Research Article

Borderline operability in hepatectomy patients is associated with higher rates of failure to rescue after severe complications

Bradford J. Kim MD, MHS,

Bradford J. Kim MD, MHS

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Ching-Wei D. Tzeng MD,

Ching-Wei D. Tzeng MD

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Amanda B. Cooper MD,

Amanda B. Cooper MD

Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania

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Jean-Nicolas Vauthey MD,

Jean-Nicolas Vauthey MD

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Thomas A. Aloia MD,

Corresponding Author

Thomas A. Aloia MD

[email protected]

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

Correspondence to: Thomas A. Aloia, MD, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Herman Pressler Drive, Unit 1484, Houston, TX 77030. Fax: +713-745-6287. E-mail: [email protected]

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Bradford J. Kim MD, MHS,

Bradford J. Kim MD, MHS

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Ching-Wei D. Tzeng MD,

Ching-Wei D. Tzeng MD

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Amanda B. Cooper MD,

Amanda B. Cooper MD

Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania

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Jean-Nicolas Vauthey MD,

Jean-Nicolas Vauthey MD

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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Thomas A. Aloia MD,

Corresponding Author

Thomas A. Aloia MD

[email protected]

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

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First published: 03 November 2016

https://doi.org/10.1002/jso.24506

Citations: 11

Funding Sources: Supported by National Institutes of Health (NIH) grant T32 CA009599.

A portion of the data in this manuscript was presented at the Americas Hepato-Pancreato-Biliary Association (AHPBA) Annual Meeting, Miami, FL, February 21, 2014.

ACS-NSQIP Disclaimer for Participant Use File Research: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Abstract

Background/Objective

To understand the influence of age and comorbidities, this study analyzed the incidence and risk factors for post-hepatectomy morbidity/mortality in patients with “borderline” (BL) operability, defined by the preoperative factors: age ≥75 years, dependent function, lung disease, ascites/varices, myocardial infarction, stroke, steroids, weight loss >10%, and/or sepsis.

Methods

All elective hepatectomies were identified in the 2005–2013 ACS-NSQIP database. Predictors of 30-day morbidity/mortality in BL patients were analyzed.

Results

A 3,574/15,920 (22.4%) patients met BL criteria. Despite non-BL and BL patients undergoing similar magnitude hepatectomies (P > 0.4), BL patients had higher severe complication (SC, 23.3% vs. 15.3%) and mortality rates (3.7% vs. 1.2%, P < 0.001). BL patients with any SC experienced a 14.1% mortality rate (vs. 7.3%, non-BL, P < 0.001). Independent risk factors for SC in BL patients included American Society of Anesthesiologists (ASA) score >3 (odds ratio, OR – 1.29), smoking (OR – 1.41), albumin <3.5 g/dl (OR – 1.36), bilirubin >1 (OR – 2.21), operative time >240 min (OR – 1.58), additional colorectal procedure (OR – 1.78), and concurrent procedure (OR – 1.73, all P < 0.05). Independent predictors of mortality included disseminated cancer (OR – 0.44), albumin <3.5 g/dl (OR – 1.94), thrombocytopenia (OR – 1.95), and extended/right hepatectomy (OR – 2.81, all P < 0.01).

Conclusions

Hepatectomy patients meeting BL criteria have an overall post-hepatectomy mortality rate that is triple that of non-BL patients. With less clinical reserve, BL patients who suffer SC are at greater risk of post-hepatectomy death. J. Surg. Oncol. 2017;115:337–343. © 2016 Wiley Periodicals, Inc.

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Volume115, Issue3

March 1, 2017

Pages 337-343

Borderline operability in hepatectomy patients is associated with higher rates of failure to rescue after severe complications

Abstract

Background/Objective

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

Information

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Borderline operability in hepatectomy patients is associated with higher rates of failure to rescue after severe complications

Abstract

Background/Objective

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

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