title: Simultaneous colorectal and hepatic procedures for colorectal cancer result in increased morbidity but equivalent mortality compared with colorectal or hepatic procedures alone: outcomes from the National Surgical Quality Improvement Program.
abstract: BACKGROUND
  Simultaneous colorectal and hepatic surgery for colorectal cancer (CRC) is increasing as surgery becomes safer and less invasive. There is controversy regarding the morbidity associated with simultaneous, compared with separate or staged, resections.
  
  
  METHODS
  Data for 2005-2008 from the National Surgical Quality Improvement Program (NSQIP) were used to compare morbidity after 19,925 colorectal procedures for CRC (CR group), 2295 hepatic resections for metastatic CRC (HEP group), and 314 simultaneous colorectal and hepatic resections (SIM group).
  
  
  RESULTS
  An increasing number of simultaneous resections were performed per year. Fewer major colorectal and liver resections were performed in the SIM than in the CR and HEP groups. Patients in the SIM group had a longer operative time and postoperative length of stay compared with those in either the CR or HEP groups. Simultaneous procedures resulted in higher rates of postoperative morbidity and major morbidity than CR procedures, but not HEP procedures. This difference was driven by higher rates of wound and organ space infections, and a greater incidence of septic shock. Mortality rates did not differ among the groups.
  
  
  CONCLUSIONS
  Hospitals in the NSQIP are performing more simultaneous colonic and hepatic resections for CRC. These procedures are associated with increases in operative time, length of stay and rate of perioperative complications. Simultaneous procedures do not, however, increase perioperative mortality.
authors: Program for Liver, Pancreas and Foregut Tumors, Penn State Cancer Institute, Penn State College of Medicine, Hershey, PA 17033-0850, USA.
authors: Osama H
authors: OH
authors: Hamed
authors: Neil H
authors: NH
authors: Bhayani
authors: Gail
authors: G
authors: Ortenzi
authors: Jussuf T
authors: JT
authors: Kaifi
authors: Eric T
authors: ET
authors: Kimchi
authors: Kevin F
authors: KF
authors: Staveley-O'Carroll
authors: Niraj J
authors: NJ
authors: Gusani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003082:Colectomy / Q000009:adverse effects* / Q000401:mortality / Q000592:standards; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality / Q000592:standards; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000592:standards; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult