Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Simultaneous resection of synchronous colorectal liver metastasis: Feasibility and development of a prediction model

  • Mufaddal Kazi (Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital) ;
  • Shraddha Patkar (Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital) ;
  • Prerak Patel (Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital) ;
  • Aditya Kunte (Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital) ;
  • Ashwin Desouza (Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital) ;
  • Avanish Saklani (Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital) ;
  • Mahesh Goel (Division of Gastrointestinal and Hepatopancreaticobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital)
  • Received : 2022.06.15
  • Accepted : 2022.07.21
  • Published : 2023.02.28
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Abstract

Backgrounds/Aims: Timing of resection for synchronous colorectal liver metastasis (CRLM) has been debated for decades. The aim of the present study was to assess the feasibility of simultaneous resection of CRLM in terms of major complications and develop a prediction model for safe resections. Methods: A retrospective single-center study of synchronous, resectable CRLM, operated between 2013 and 2021 was conducted. Upper limit of 95% confidence interval (CI) of major complications (≥ grade IIIA) was set at 40% as the safety threshold. Logistic regression was used to determine predictors of morbidity. Prediction model was internally validated by bootstrap estimates, Harrell's C-index, and correlation of predicted and observed estimates. Results: Ninety-two patients were operated. Of them, 41.3% had rectal cancers. Major hepatectomy (≥ 4 segments) was performed for 25 patients (27.2%). Major complications occurred in 20 patients (21.7%, 95% CI: 13.8%-31.5%). Predictors of complications were the presence of comorbidities and major hepatectomy (area under the ROC curve: 0.692). Unacceptable level of morbidity (≥ 40%) was encountered in patients with comorbidities who underwent major hepatectomy. Conclusions: Simultaneous bowel and CRLM resection appear to be safe. However, caution should be exercised when combining major liver resections with bowel resection in patients with comorbid conditions.

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References

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