Borderline operability in hepatectomy patients is associated with higher rates of failure to rescue after severe complications.
OBJECTIVE
To understand the influence of age and comorbidities, this study analyzed the incidence and risk factors for post-hepatectomy morbidity/mortality in patients with "borderline" (BL) operability, defined by the preoperative factors: age ≥75 years, dependent function, lung disease, ascites/varices, myocardial infarction, stroke, steroids, weight loss >10%, and/or sepsis.


METHODS
All elective hepatectomies were identified in the 2005-2013 ACS-NSQIP database. Predictors of 30-day morbidity/mortality in BL patients were analyzed.


RESULTS
A 3,574/15,920 (22.4%) patients met BL criteria. Despite non-BL and BL patients undergoing similar magnitude hepatectomies (P > 0.4), BL patients had higher severe complication (SC, 23.3% vs. 15.3%) and mortality rates (3.7% vs. 1.2%, P < 0.001). BL patients with any SC experienced a 14.1% mortality rate (vs. 7.3%, non-BL, P < 0.001). Independent risk factors for SC in BL patients included American Society of Anesthesiologists (ASA) score >3 (odds ratio, OR - 1.29), smoking (OR - 1.41), albumin <3.5 g/dl (OR - 1.36), bilirubin >1 (OR - 2.21), operative time >240 min (OR - 1.58), additional colorectal procedure (OR - 1.78), and concurrent procedure (OR - 1.73, all P < 0.05). Independent predictors of mortality included disseminated cancer (OR - 0.44), albumin <3.5 g/dl (OR - 1.94), thrombocytopenia (OR - 1.95), and extended/right hepatectomy (OR - 2.81, all P < 0.01).


CONCLUSIONS
Hepatectomy patients meeting BL criteria have an overall post-hepatectomy mortality rate that is triple that of non-BL patients. With less clinical reserve, BL patients who suffer SC are at greater risk of post-hepatectomy death. J. Surg. Oncol. 2017;115:337-343. © 2016 Wiley Periodicals, Inc.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Bradford J
BJ
Kim
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Ching-Wei D
CD
Tzeng
Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania.
Amanda B
AB
Cooper
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Jean-Nicolas
JN
Vauthey
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Thomas A
TA
Aloia
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D055815:Young Adult
comorbidity; patient selection; surgical outcomes