title: Colorectal liver metastasis surgery: analysis of risk factors predicting postoperative complications in relation to the extent of resection.
abstract: OBJECTIVE
  Despite advances in diagnosis and treatment, the rate of complications after resection for colorectal liver metastases remains high. An awareness of risk factors is essential for the rates of morbidity and mortality to fall to optimal levels.
  
  
  METHODS
  Of the 240 patients who underwent resection for the first manifestation of colorectal liver metastases, 49 patients with lobectomy or extended hepatectomy (major resections) and 58 with wedge resections within only one liver segment (minor resections) form the basis of this report. A total of 16 variables were analyzed to find the risk factors linked to postoperative morbidity and mortality.
  
  
  RESULTS
  Thirty-four patients (31.8%) suffered postoperative complications, and one patient died during the hospital stay (0.9%). In the major resection group, multivariate analysis showed that neoadjuvant chemotherapy [odds ratio (OR): 2.4; p = 0.005], vascular clamping (OR: 1.4; p = 0.008), and intraoperative blood loss with transfusion of three to six packed red cell units (OR: 1.2; p = 0.029) were significantly associated with postoperative morbidity. Vascular clamping was an independent predictor for biliary fistula (OR: 1.2; p = 0.029). Postoperative temporary liver failure was influenced by neoadjuvant chemotherapy (OR: 3.4; p = 0.010), vascular clamping (OR: 1.5; p = 0.015), and requirement of blood transfusion (OR: 2.1; p = 0.016). After minor resections, only a decreased postoperative serum cholinesterase B level was an independent predictor for complications (OR: 2.2; p = 0.001), as well as for hemorrhage (OR: 1.6; p = 0.023). Postoperative mortality was not predicted by any of the factors that were analyzed.
  
  
  CONCLUSIONS
  Factors for complications differ depending on the extent of colorectal liver metastasis resection. Only knowledge and particular consideration of these factors may provide for an optimal postoperative outcome for the individual patient.
authors.affiliation: Department of General, Thoracic, and Vascular Surgery, University of Dresden, Dresden, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Konopke
authors.forename: Stephan
authors.initials: S
authors.lastname: Kersting
authors.forename: Alfred
authors.initials: A
authors.lastname: Bunk
authors.forename: Janine
authors.initials: J
authors.lastname: Dietrich
authors.forename: Axel
authors.initials: A
authors.lastname: Denz
authors.forename: Jörg
authors.initials: J
authors.lastname: Gastmeier
authors.forename: Hans-Detlev
authors.initials: HD
authors.lastname: Saeger
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D001808:Blood Vessels / Q000473:pathology; D015179:Colorectal Neoplasms / Q000473:pathology*; D003250:Constriction; D003710:Demography; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis*; D011300:Preoperative Care; D012307:Risk Factors; D013997:Time Factors