Fellow in Complex General Surgical Oncology Moffitt Cancer Institute Tampa, Florida, United States
Disclosure: Disclosure information not submitted.
Participants should be aware of the following financial/non-financial relationships:
Andrew J. Sinnamon, MD, MSCE: Disclosure information not submitted.
Introduction: Simultaneous hepatic and visceral oncologic resections (SHVR) are increasingly being performed for managing metastatic and primary lesions when considering sequence of oncologic therapy, with other alternatives available and data supporting individualized approaches. We sought to develop a patient risk stratification tool to guide individualized decisions when considering SHVR with a focus on postoperative recovery and early return to intended oncologic therapy (RIOT).
Methods: Patients undergoing hepatectomy with or without SHVR were included for study (2016-2021). Textbook surgical outcome (TSO) was the primary outcome defined as: no 90-day-grade≥3 complication, -reoperation, -readmission, or -mortality, and no prolonged length of stay. The secondary outcome was RIOT, measured in days. Multivariate regression was done to identify factors associated with non-TSO and to develop a risk score. Classification and regression tree (CART) analysis was performed for hierarchical risk stratification. Time-to-event analysis was performed to examine and compare RIOT between groups.
Results: In all, 537 patients met study criteria with 125 SHVR. The overall rate of TSO was 71% (n=383); 79% in non-SHVR and 46% in SHVR (p< 0.001). Type of visceral resection (right colon/small bowel OR 4.63 [95% CI 2.66-8.08], left colon/rectum OR 6.09 [2.59-14.3], stomach/pancreas OR 6.69 [1.46-30.7], multivisceral 10.9 [3.03-39.5]) was the strongest predictor of non-TSO. A composite score was developed yielding three risk-strata for non-TSO (score 0-2 89% vs. 3-5 67% vs. ≥6 37%, p< 0.001), and good discrimination (C 0.73). CART analysis was congruent with the risk score and identified SHVR as the most important determinant of TSO (p< 0.001). Time-to-event analysis revealed that both TSO and the risk strata were associated with faster time to RIOT (Figure).
Conclusions: SHVR was associated with reduced rate of TSO which in turn is associated with delayed RIOT. A composite patient-specific risk score and CART based decision-tree is presented and can facilitate optimal treatment and individualized surgical and oncologic treatment planning when considering simultaneous resections and timing of chemotherapy.
Learning Objectives:
Describe the association between simultaneous visceral resection at time of hepatectomy with postoperative recovery (textbook surgical outcome).
Calculate risk for failure to achieve textbook surgical outcome for a patient undergoing hepatectomy to assist with individualized therapeutic decision-making.
Describe the relationship between postoperative recovery (textbook surgical outcome) and earlier return to intended oncologic therapy.
