Impact of complications after surgery for colorectal liver metastasis on patient survival.
BACKGROUND
In some patients with colorectal liver metastases it is not clear whether liver resection or isolated liver perfusion is the best treatment option. For instance, the risk of complications after surgery may be so substantial and affect subsequent survival. Aim of the present study is to compare complication occurrence and its effect on survival after liver resection and perfusion.


METHODS
Patient records of all 225 patients with colorectal liver metastases treated with liver resection (n = 121) or liver perfusion (n = 104) in the period 1997-2006 were reviewed for complications during the initial hospitalisation until 30 d after discharge, and to assess patient survival until the last hospital visit. Median duration of follow-up was 38 mo for overall survival and 22 mo for survival after surgery.


RESULTS
Complications occurred less often in patients undergoing resection than perfusion (29.8% versus 49.0%, X(2) = 8.77, P < 0.01). Postoperative mortality rates were similar in both groups (4.1% and 4.8%, respectively). As expected, long term survival after liver surgery was better in the resection group: at 3 y, 60% of patients survived in the resection group, compared with 22% after liver perfusion (log rank X(2) = 35.29 P < 0.001). However, liver resection patients with postoperative complications, had similar survival as perfusion patients without complications (log rank X(2) = 2.45, p = 0.12). This remained after adjustment for differences between the patient groups at time of surgery.


CONCLUSIONS
Liver resection has superior long-term survival, but survival is significantly reduced by the occurrence of post-surgical complications. When complications occur after liver resection, survival is comparable to patients who underwent uncomplicated liver perfusion.
Schepers
Abbey
A
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Mieog
Sven
S
van de Burg
Boudewijn Borger
BB
van Schaik
Jan
J
Liefers
Gerrit-Jan
GJ
Marang-van de Mheen
Perla J
PJ
D017115:Catheter Ablation / Q000401:mortality; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000401:mortality; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis