eP133 - Contemporary Analysis of Major Post-Operative Morbidity in Simultaneous Colorectal and Liver Surgery for Metastatic Colorectal Adenocaricnoma

ePoster Presenter(s)

• 

  Lynn Hakki, MD

  General Surgery Resident
  NYP - Columbia University Medical Center
  NYP - Columbia University Medical Center
  New York, NY, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• LS

  Lauren E. Schleimer, MD

  Research Fellow
  Memorial Sloan Kettering Cancer Center
  New York, New York, United States

  Disclosure information not submitted.
• KS

  Kenneth Seier, MS

  Research Biostatistician
  Memorial Sloan Kettering Cancer Center
  New York, New York, United States

  Disclosure information not submitted.
• 

  Alice C. Wei, MD MSc

  Attending Surgeon
  Memorial Sloan Kettering
  New York, New York, United States

  Disclosure information not submitted.
• TK

  T Peter Kingham, Md

  Professor
  Memorial Sloan Kettering Cancer Center
  New York, New York, United States

  Disclosure information not submitted.
• KS

  Kevin Soares, MD

  Assistant Attending Surgeon
  Memorial Sloan Kettering Cancer Center
  New York, New York, United States

  Disclosure information not submitted.
• WJ

  William Jarnagin, MD, FACS

  Chief, HPB Service, MSKCC, Professor of Surgery, Weill Cornell Medical College
  Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College
  New York, New York, United States

  Disclosure information not submitted.
• JD

  Jeffrey Drebin, MD, PhD

  Chair of the Department of Surgery
  Memorial Sloan Kettering Cancer Center
  New York, New York, United States

  Disclosure information not submitted.
• 

  Maria Widmar, MD, MPH, FACS (she/her/hers)

  Assistant Attending
  Memorial Sloan Kettering Cancer Center
  Weill Cornell Medical Center
  New York, New York, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• IW

  Iris Wei, MD

  Surgeon
  Memorial Sloan Kettering Cancer Center
  New York City, New York, United States

  Disclosure information not submitted.
• 

  J. Joshua Smith, MD, PhD

  Associate Attending
  Memorial Sloan Kettering Cancer Center
  MSKCC, Weill Cornell Medical College
  New York, New York, United States

  Disclosure information not submitted.
• 

  Emmanouil Pappou, MD, PhD

  Assistant Attending
  Memorial Sloan Kettering Cancer Center
  new York, New York, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• 

  Garrett M. Nash, MD, MPH

  Vice Chair, Department of Surgery
  Memorial Sloan Kettering
  New York, New York, United States

  Disclosure information not submitted.
• 

  Philip B. Paty, FASCRS, FACS

  Attending Surgeon, Colorectal Surgery Service
  Memorial Sloan Kettering Cancer Center
  New York, New York, United States

  Disclosure information not submitted.
• 

  Julio Garcia-Aguilar, MD, PhD (he/him/his)

  Chief Attending
  Memorial Sloan Kettering Cancer Center
  Memorial Sloan Kettering Cancer Center
  New York, New York, United States

  Disclosure information not submitted.
• MG

  Mithat Gonen, PhD

  Attending Biostatistician
  Memorial Sloan Kettering Cancer Center
  New York, New York, United States

  Disclosure information not submitted.
• 

  Martin Weiser, MD

  Attending Surgeon and Professor
  Memorial Sloan Kettering Cancer Center
  Cornell Medical College
  New York, New York, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• MD

  Michael D'Angelica, MD, FACS

  Attending Surgeon
  Memorial Sloan Kettering Cancer Center
  New York, New York, United States

  Disclosure information not submitted.

Purpose/Background: The optimal strategy for sequencing surgical management of colorectal cancer with liver metastasis has been debated for decades. The major challenge in combined resections is minimizing post-operative morbidity. This study investigates the type, timing and risk factors for major post-operative morbidity in a modern cohort of patients undergoing combined liver and colorectal surgery at a high-volume cancer center.Methods/Interventions: Consecutive patients undergoing combined colorectal procedure and liver resection from November 2013 to September 2022 were reviewed for 30 and 90-day post-operative complications using established criteria. Major complication was defined as Clavien-Dindo grade 3 or higher. Cytoreductive surgeries or locally recurrent colorectal disease were excluded. Logistic regression was used to evaluate associations with major complications. P-value < 0.05 was considered statistically significant.Results/Outcomes: Over the 9-year period examined, 580 combined procedures were performed with 22% (n=127) and 25% (n=144) of patients experiencing major complications at 30 and 90 days; 90-day mortality was only 0.2% (n=2). Colorectal procedures included resection of primary tumor (41% rectal, 53% colon) or ostomy reversal alone (6%). Major liver resections (≥4 segments) comprised 11% of the liver procedures. The most frequent 30-day major complications were surgical site infection (n=90, 16%), bile leak (n=27, 5%), pulmonary complications (n=23, 4%), ascites (n=12, 2%), and anastomotic leak (n=12, 2%) (Table 1). Delayed presentation of surgical site infection, anastomotic and bile leaks were the most common complications presenting between 31 and 90 days postoperatively.On multivariable analysis, ostomy takedown (HR 2.68, 95% CI 1.64-4.39), major liver resection (HR 2.16, 95% CI 1.21-3.84), blood transfusion (HR 2.53, 95% CI 1.52-4.20) and more recent year of surgery (HR 1.12, 95% CI 1.03-1.21) were significantly associated with major complication. Intra-abdominal drain placement (HR 0.53, 95% CI 0.34-0.83) was associated with lower rates of major complication.Conclusion/

Discussion: Major complications are common among patients undergoing combined colorectal procedure and liver resection; however, mortality remained very low. Complications were more common among patients undergoing major liver resection and ostomy takedown. Surgical site infection was the most common major complication and should be targeted for quality improvement. The role of drainage in high-risk procedures warrants further investigation. Table 1: Type and Timing of Major Post-Operative Complications