title: Perioperative complications influence recurrence and survival after resection of hepatic colorectal metastases.
abstract: BACKGROUND
  Perioperative outcomes, such as blood loss, transfusions, and morbidity, have been linked to cancer-specific survival, but this is largely unsupported by prospective data.
  
  
  METHODS
  Patients from a previous, randomized trial that evaluated acute normovolemic hemodilution during major hepatectomy (≥3 segments) were reevaluated and those with metastatic colorectal cancer (n = 90) were selected for analysis. Survival data were obtained from the medical record. Disease extent was measured using a clinical-risk score (CRS). Log-rank test and Cox proportional hazard model were used to evaluate recurrence-free survival (RFS) and overall survival (OS).
  
  
  RESULTS
  Median follow-up was 71 months. The CRS was ≥3 in 45 % of patients; 59 % had extrahepatic procedures. Morbidity and mortality were 33 and 2 %, respectively. Postoperative chemotherapy was given to 87 % of patients (78/90) starting at a median of 6 weeks. RFS and OS were 29 and 60 months, respectively. Postoperative morbidity significantly reduced RFS (23 vs. 69 months; P < 0.001) and OS (28 vs. 74 months; P < 0.001) on uni- and multi-variate analysis; positive resection margins and high CRS also were significant factors. Delayed initiation of postoperative chemotherapy (≥8 weeks) was common in patients with complications (37 vs. 12 %; P = 0.01).
  
  
  CONCLUSIONS
  In this selected cohort of patients from a previous RCT, perioperative morbidity was strongly (and independently) associated with cancer-specific outcome. It also was associated with delayed initiation of postoperative chemotherapy, the impact of which on survival is unclear.
authors.affiliation: Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: C
authors.initials: C
authors.lastname: Correa-Gallego
authors.forename: M
authors.initials: M
authors.lastname: Gonen
authors.forename: M
authors.initials: M
authors.lastname: Fischer
authors.forename: F
authors.initials: F
authors.lastname: Grant
authors.forename: N E
authors.initials: NE
authors.lastname: Kemeny
authors.forename: V
authors.initials: V
authors.lastname: Arslan-Carlon
authors.forename: T P
authors.initials: TP
authors.lastname: Kingham
authors.forename: R P
authors.initials: RP
authors.lastname: Dematteo
authors.forename: Y
authors.initials: Y
authors.lastname: Fong
authors.forename: P J
authors.initials: PJ
authors.lastname: Allen
authors.forename: M I
authors.initials: MI
authors.lastname: D'Angelica
authors.forename: W R
authors.initials: WR
authors.lastname: Jarnagin
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D016063:Blood Loss, Surgical; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D004868:Equipment Failure; D005260:Female; D006438:Hemodilution; D006498:Hepatectomy / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D045823:Ileus / Q000209:etiology; D015918:Infusion Pumps, Implantable / Q000009:adverse effects; D007902:Length of Stay; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000209:etiology; D018365:Neoplasm, Residual; D012008:Recurrence; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000209:etiology; D015996:Survival Rate; D013610:Tachycardia / Q000209:etiology; D013997:Time Factors; D065227:Transfusion Reaction; D020246:Venous Thrombosis / Q000209:etiology