Comprehensive Complication Index Validates Improved Outcomes Over Time Despite Increased Complexity in 3707 Consecutive Hepatectomies

Cloyd, Jordan M.; Mizuno, Takashi; Kawaguchi, Yoshikuni; Lillemoe, Heather A.; Karagkounis, Georgios; Omichi, Kiyohiko; Chun, Yun Shin; Tzeng, Ching Wei D.; Odisio, Bruno C.; Huang, Steven Y.; Hicks, Marshall E.; Wei, S.; Aloia, Thomas A.; Vauthey, Jean Nicolas

doi:10.1097/sla.0000000000003043

Cited by 58 publications

(46 citation statements)

References 56 publications

(62 reference statements)

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“…This treatment group consists primarily of patients with limited metastatic disease. The improvement over time is likely due to improved surgical techniques and perioperative care 50,51 . The difference in OS between the different treatment groups in our study suggests that the prognosis of stage IV patients is more diverse than clinicians generally realize.…”

Section: Discussionsupporting

confidence: 88%

Informing metastatic colorectal cancer patients by quantifying multiple scenarios for survival time based on real‐life data

Hamers

Elferink

Stellato

et al. 2020

Intl Journal of Cancer

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Reported median overall survival (mOS) in metastatic colorectal cancer (mCRC) patients participating in systemic therapy trials has increased to over 30 months. It is uncertain whether trial results translate to real-life populations. Moreover, patients prefer presentation of multiple survival scenarios. Population-based data of all stage IV CRC patients diagnosed between 2008 and 2016 were obtained from the Netherlands Cancer Registry, which has a case ascertainment completeness surpassing 95%. We calculated the following percentiles (scenarios) of OS per year of diagnosis for the total population, and for treatment subgroups: 10th (best-case), 25th (upper-typical), 50th (median), 75th (lower-typical) and 90th (worst-case). Twenty-five percent of patients did not receive any antitumor treatment. From 2008 to 2016, mOS of the total population (n = 27275) remained unchanged at approximately 12 months. OS improved only for the upper-typical and best-case patients; by 4.2 to 29.1 months (P < .001), and by 6 to 62 months (P < .001), respectively. No clinically relevant change was observed among patients who received systemic therapy, with mOS close to 15 months and best-case scenario approximately 40 months. A clinically relevant improvement in survival over time was observed in patients who initially received metastasectomy and/or HIPEC only. In contrast to the wide belief based on trial data that mOS of mCRC patients receiving systemic therapy has improved substantially, improvement could not be demonstrated in our real-life population. Clinicians should consider quoting multiple survival scenarios based on real-life data instead of point estimates from clinical trials, when informing patients about their life expectancy.

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Section: Discussionsupporting

confidence: 88%

Informing metastatic colorectal cancer patients by quantifying multiple scenarios for survival time based on real‐life data

Hamers

Elferink

Stellato

et al. 2020

Intl Journal of Cancer

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“…The CCI was initially introduced in general surgery and has become increasingly adopted as a clinical endpoint in surgical trials [16][17][18]. It has additionally been validated and implemented for various procedures such as gastric cancer surgery [19], hyperthermic intraperitoneal chemotherapy [7], and natural orifice transluminal endoscopic surgery [20].…”

Section: Discussionmentioning

confidence: 99%

The comprehensive complication index (CCI): proposal of a new reporting standard for complications in major urological surgery

et al. 2020

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Purpose The comprehensive complication index (CCI) is a new tool for reporting the cumulative burden of postoperative complications on a continuous scale. This study validates the CCI for urological surgery and its benefits over the Clavien-Dindo-Classification (Clavien). Material and methods Data from a prospectively maintained data base of all consecutive patients at a university care-center was analyzed. Complications after radical cystectomy (RC), radical prostatectomy (RP), and partial nephrectomy (PN) were classified using the CCI and Clavien system. Differences in complications between the CCI and the Clavien were assessed and correlation analyses performed. Sample size calculations for hypothetical clinical trials were compared between CCI and Clavien to evaluate whether the CCI would reduce the number of required patients in a clinical trial. Results 682 patients (172 RC, 297 RP, 213 PN) were analyzed. Overall, 9.4-46.6% of patients had > 1 complication cumulatively assessed with the CCI resulting in an upgrading in the Clavien classification for 2.4-32.4% of patients. Therefore, scores between the systems differed for RC: CCI (mean ± standard deviation) 26.

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“…Morbidity was evaluated according to the comprehensive complication index described by Slankamenac et al 20 (available at http://www.assessurgery.com/calculator_single/). Severe morbidity was defined by a CCI ≥ 26.2, which refers to one complication of Clavien-Dindo grade IIIa 21 .…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension

et al. 2021

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Comprehensive Complication Index Validates Improved Outcomes Over Time Despite Increased Complexity in 3707 Consecutive Hepatectomies

Cited by 58 publications

References 56 publications

Informing metastatic colorectal cancer patients by quantifying multiple scenarios for survival time based on real‐life data

Informing metastatic colorectal cancer patients by quantifying multiple scenarios for survival time based on real‐life data

The comprehensive complication index (CCI): proposal of a new reporting standard for complications in major urological surgery

Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension

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