A multi-institutional analysis of 429 patients undergoing major hepatectomy for colorectal cancer liver metastases: The impact of concomitant bile duct resection on survival.
BACKGROUND
Data are lacking on long-term outcomes of patients undergoing major hepatectomy requiring bile duct resection (BDR) for the treatment of colorectal cancer liver metastases.


METHODS
Patients who underwent major hepatectomy (≥3 segments) for metastatic colorectal cancer from 2000-2010 at three US academic institutions were included. The primary outcome was disease-specific survival (DSS).


RESULTS
Of 429 patients, nine (2.1%) underwent BDR, which was associated with pre-operative portal vein embolization (25.0% vs. 4.3%; P = 0.049). There were no significant differences in age, ASA class, margin status, number of lesions, tumor size, cirrhosis, perineural invasion, or lymphovascular invasion. BDR was independently associated with increased postoperative major complications (OR: 6.22; 95%CI:1.44-26.97; P = 0.015). There were no differences in length of stay, reoperation, readmission, or 30-day mortality. Patients who underwent BDR had markedly decreased DSS (9.3 vs. 39.9 mo; P = 0.002). When accounting for differences between the two groups, the need for BDR was independently associated with reduced DSS (HR: 3.06; 95%CI:1.12-8.34; P = 0.029).


CONCLUSIONS
Major hepatectomy with concomitant bile duct resection is seldom performed in patients undergoing resection of colorectal cancer liver metastases and is associated with higher major morbidity and reduced disease-specific survival compared to major hepatectomy alone. Stringent selection criteria should be applied when patients may need bile duct resection during hepatectomy for colorectal cancer liver metastases.
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Lauren M
LM
Postlewait
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Malcolm H
MH
Squires
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
David A
DA
Kooby
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Sharon M
SM
Weber
Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky.
Charles R
CR
Scoggins
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Kenneth
K
Cardona
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Clifford S
CS
Cho
Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky.
Robert C G
RC
Martin
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Emily R
ER
Winslow
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Shishir K
SK
Maithel
D001652:Bile Ducts / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation; D015996:Survival Rate
bile duct resection; colorectal cancer; hepatectomy; metastasis; outcomes