Morbidity of Staged Proctectomy After Hepatectomy for Colorectal Cancer

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dc.contributor.author Tzeng, Ching-Wei
dc.contributor.author Aloia, Thomas
dc.contributor.author Vauthey, Jean-Nicolas
dc.contributor.author Chang, George
dc.contributor.author Ellis, Lee
dc.contributor.author Feig, Barry
dc.contributor.author Curley, Steven
dc.contributor.author Skibber, John
dc.contributor.author Abdalla, Eddie
dc.contributor.author You, Nancy
dc.contributor.author Rodriguez-Bigas, Miguel
dc.date.accessioned 2015-11-20T08:49:44Z
dc.date.available 2015-11-20T08:49:44Z
dc.date.copyright 2013
dc.date.issued 2015-11-20
dc.identifier.issn 1068-9265 en_US
dc.identifier.uri http://hdl.handle.net/10725/2643
dc.description.abstract Background Proctectomy after hepatectomy, or the reverse approach, is an alternative to traditional sequencing for advanced liver metastases with asymptomatic colorectal primary tumors. We sought to evaluate the surgical morbidity of proctectomy for colorectal cancer after previous liver surgery. Methods A single-institution colorectal database was queried for patients treated with proctectomy after previous hepatectomy from 2003 to 2011. Reverse-approach patients (n = 31) were matched 1:2 with a cohort of standard proctectomy patients (n = 62) using operation, age, gender, and surgeon. Perioperative factors were analyzed by univariate/multivariate models for associations with complications graded by Dindo–Clavien criteria. Results Thirty-one patients with adenocarcinoma ≤20 cm from the anal verge underwent proctectomy after hepatectomy. Median time from hepatectomy to proctectomy was 5.1 months. Median tumor distance was 8.5 cm. Before proctectomy, patients underwent 28 (90 %) major hepatectomies and 7 (22 %) portal vein embolizations. There were no perioperative deaths. Reverse-approach patients did not differ from control patients in operation, demographics, body mass index (BMI), comorbidities, tumor distance, operative time, estimated blood loss, length of stay, or complication rates (p > 0.05). Grade 2 or higher complications developed in 42 % of reverse-approach and 27 % of standard proctectomies (p = 0.17). Grade 3 or higher complications developed in 10 % and 8 %, respectively (p = 1.00). Independent predictors of complications of grade 2 or higher were BMI ≥30 kg/m2 (p = 0.007), operative time ≥300 min (p = 0.012), intraoperative transfusion (p = 0.044), concurrent procedures (p = 0.024), and age ≥50 years (p = 0.030). Conclusions Risk factors for morbidity of staged proctectomy are similar to those for standard proctectomy. In selected patients, the reverse-approach proctectomy is safe with acceptable morbidity. en_US
dc.language.iso en en_US
dc.title Morbidity of Staged Proctectomy After Hepatectomy for Colorectal Cancer en_US
dc.type Article en_US
dc.description.version Published en_US
dc.title.subtitle A Matched Case–Control Analysis en_US
dc.author.school SOM en_US
dc.author.idnumber 201100945 en_US
dc.author.woa N/A en_US
dc.author.department N/A en_US
dc.description.embargo N/A en_US
dc.relation.journal Annals of Surgical Oncology en_US
dc.journal.volume 20 en_US
dc.journal.issue 2 en_US
dc.article.pages 482-490 en_US
dc.identifier.doi http://dx.doi.org/10.1245/s10434-012-2620-z en_US
dc.identifier.ctation Tzeng, C. W. D., Aloia, T. A., Vauthey, J. N., Chang, G. J., Ellis, L. M., Feig, B. W., ... & Rodriguez-Bigas, M. A. (2013). Morbidity of staged proctectomy after hepatectomy for colorectal cancer: a matched case–control analysis. Annals of surgical oncology, 20(2), 482-490. en_US
dc.author.email eddie.abdalla@lau.edu.lb
dc.identifier.url http://link.springer.com/article/10.1245/s10434-012-2620-z

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