Current perioperative outcomes for patients with disseminated cancer.
BACKGROUND
Surgical morbidity and mortality (M&M) for patients with disseminated malignancy (DMa) is high, and some have questioned the role of surgery. Therefore, we sought to characterize temporal trends in M&M among DMa patients, hypothesizing that surgical intervention would remain prevalent.


METHODS
We queried the American College of Surgeons National Surgical Quality Improvement Program from 2006-2010. Excluding patients undergoing a primary hepatic operation, we identified 21,755 patients with DMa. Parametric and/or nonparametric statistics and logistic regression were used to evaluate temporal trends and predictors of M&M.


RESULTS
The prevalence of surgical intervention for DMa declined slightly over the time period, from 1.9%-1.6% of all procedures (P < 0.01). Among DMa patients, the most frequent operations performed were bowel resection, other gastrointestinal procedures, and multivisceral resections, these all showed small statistically significant decreases over time (P < 0.01). The rate of emergency operations also decreased (P < 0.01). In contrast, the rate of preoperative independent functional status rose, whereas the rate of preoperative weight loss and sepsis decreased (P < 0.01). Rates of 30-d morbidity (33.7 versus 26.6%), serious morbidity (19.8 versus 14.2%), and mortality (10.4 versus 9.3%) all decreased over the study period (P < 0.05). Multivariate analysis identified standard predictors (e.g., impaired functional status, preoperative weight loss, preoperative sepsis, and hypoalbuminemia) of worse 30-d M&M.


CONCLUSIONS
Thirty-day morbidity, serious morbidity, and mortality have decreased incrementally for patients with DMa undergoing surgical intervention, but surgical intervention remains prevalent. These data further highlight the importance of careful patient selection and goal-directed therapy in patients with incurable malignancy.
Divison of Surgical Oncology, Department of Surgery, University of California at Davis Medical Center, Sacramento, California.
Sarah B
SB
Bateni
Division of Hematology/Oncology, Department of Internal Medicine, University of California at Davis Medical Center, Sacramento, California; Vice Dean UC Davis School of Medicine, University of California at Davis Medical Center, California.
Frederick J
FJ
Meyers
Divison of Surgical Oncology, Department of Surgery, University of California at Davis Medical Center, Sacramento, California.
Richard J
RJ
Bold
Divison of Surgical Oncology, Department of Surgery, University of California at Davis Medical Center, Sacramento, California. Electronic address: robert.canter@ucdmc.ucdavis.edu.
Robert J
RJ
Canter
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004067:Digestive System Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D010166:Palliative Care / Q000706:statistics & numerical data* / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
Disseminated malignancy; Morbidity and mortality; Perioperative outcomes