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Multivisceral Resection for Malignant Hepatic Lesions is Associated With Increased Morbidity
*Ann-Kristin U Friedrich1,2, *Kevin P Baratta2, *Eva A Rouanet2, *Kate H Dinh2, Giles F Whalen2, Jennifer LaFemina2
1St. Mary's Hospital, Waterbury, CT;2University of Massachusetts, Worcester, MA
Objective: Primary and secondary hepatic malignant lesions are common diagnoses and often require surgical intervention. We aim to determine if multivisceral resection involving hepatectomy impacts perioperative outcomes.
Design: Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2012. Chi-square tests and student’s t-tests were used to compare categorical and continuous variables, respectively. Logistic regression analysis adjusted for age, BMI, wound classification and ASA status was performed for all variables.
Setting: National cohort of patients registered in ACS NSQIP.
Patients: Patients who underwent hepatic resections for malignant indications with or without synchronous organ resection.
Interventions: All patients underwent hepatectomy for malignant indication.
Main Outcome Measures: Differences in 30 day morbidity or mortality between patients who did and did not have multivisceral resections during hepatectomy.
Results: 10424 patients met inclusion criteria. Indications included malignant neoplasm of liver/intrahepatic bile ducts (30%), gallbladder/extrahepatic bile duct cancer (6%) or metastatic lesions (64%). 384 patients (4%) underwent concomitant multivisceral resection. The most common organs involved in synchronous resection were colon (n=194), pancreas (n=71), spleen (n=67) and stomach (n=52). Multivisceral resection was associated with a longer length of stay (8 vs 12 days, p<0.001) and increased risk of overall complications (OR 2.4, p<0.001), including wound, respiratory and infectious complications and stroke, bleeding and myocardial infarction. 30-day mortality was similar.
Conclusions: In this national cohort of hepatectomy patients, synchronous resection of additional organs was associated with significantly higher 30-day morbidity and comparable 30-day mortality rates. This increased risk for complications associated with a multivisceral approach should be considered when planning a hepatic resection for malignant lesions.
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