Simultaneous Resections of Colorectal Cancer and Synchronous Liver Metastases: A Multi-institutional Analysis

Reddy, Srinevas K.; Pawlik, Timothy M.; Zorzi, Daria; Gleisner, Ana; Ribero, Dario; Assumpção, Lia; Barbas, Andrew S.; Abdalla, Eddie K.; Choti, Michael A.; Vauthey, Jean Nicolas; Ludwig, Kirk; Mantyh, Christopher R.; Morse, Michael A.; Clary, Bryan M.

doi:10.1245/s10434-007-9522-5

Cited by 381 publications

(333 citation statements)

References 34 publications

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“…In 2004, Dindo et al proposed a modification that included a new five-grade classification system with the possibility of combining grades; ''disability'' was added to the system, ''hospital stay'' was eliminated as a complication and ''organ failure'' was changed to carry more weight in grading [12]. The so-called ''Clavien-Dindo'' classification has been adapted for use in general surgery [10] and for other surgical subspecialties such as gastroenterology/hepatology [3,11,17,[22][23][24][25]28], urology [19], and nephrology [18,27]. Given this system appears useful for general surgery and other specialties, we explored its use in orthopaedic surgery.…”

Section: Introductionmentioning

confidence: 99%

Reliability of a Complication Classification System for Orthopaedic Surgery

Sink

Leunig

Zaltz³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

247

168

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Background Quality of health care and safety have been emphasized by various professional and governmental groups. However, no standardized method exists for grading and reporting complications in orthopaedic surgery. Conclusions regarding outcomes are incomplete without a standardized, objective complication grading scheme applied concurrently. The general surgery literature has the Clavien-Dindo classification that meets the above criteria.Questions/purposes We asked whether a previously reported classification would show high intraobserver and interobserver reliabilities when modified for orthopaedic surgery specifically looking at hip preservation surgery. We therefore determined the interreader and intrareader reliabilities of the adapted classification scheme as applied to hip preservation surgery. Methods We adapted the validated Clavien-Dindo complication classification system and tested its reliability for orthopaedic surgery, specifically hip preservation surgery. There are five grades based on the treatment required to manage the complication and the potential for long-term morbidity. Forty-four complication scenarios were created from a prospective multicenter database of hip preservation procedures and from the literature. Ten readers who perform hip surgery at eight centers in three countries graded the scenarios at two different times. Fleiss' and Cohen's j statistics were performed for interobserver and intraobserver reliabilities, respectively. Results The overall Fleiss' j value for interobserver reliability was 0.887 (95% CI, 0.855-0.891). The weighted j was 0.925 (95% CI, 0.894-0.956) for Grade I, 0.838 (95% CI, 0.807-0.869) for Grade II, 0.87 (95% CI, 0.835-0.866) for Grade III, and 0.898 (95% CI, 0.866-0.929) for

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Section: Introductionmentioning

confidence: 99%

Reliability of a Complication Classification System for Orthopaedic Surgery

Sink

Leunig

Zaltz³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

247

168

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“…[5][6][7][8][9] Historically, patients were managed with resection of the primary and subsequent systemic therapy prior to consideration of hepatectomy in order to best select patients for this complex and potentially morbid procedure. However, recent evidence suggests that simultaneous colorectal/liver resection (SCLR) of the primary tumor and the liver metastases might be an attractive option, 10 but the safety of this strategy has not been explored outside of modest single or multiinstitutional experiences.…”

Section: Introductionmentioning

confidence: 99%

Is There a Role for Simultaneous Hepatic and Colorectal Resections? A Contemporary View from NSQIP

Worni

Mantyh

Akushevich

et al. 2012

Journal of Gastrointestinal Surgery

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Introduction The optimal timing of primary and metastatic tumor management in patients with synchronous hepatic colorectal metastases remains controversial. We aimed to compare perioperative outcomes of simultaneous colorectal/liver resection (SCLR) with isolated resections utilizing a national clinical database. Methods NSQIP data from 2005 to 2009 were examined to construct risk-adjusted generalized linear models and to calculate group-specific predicted estimates. These were used to compare 30-day perioperative outcomes among patients undergoing SCLR with colorectal (CR) and liver resections (LR) only in patients with metastatic colorectal cancer. Results A total of 3,983 patients were identified, who underwent SCLR (192), LR (1,857), or CR (1,934). Rectal resection was performed in 45 (23.4 %) SCLR patients and 269 (13.9 %) CR patients (p<0.001). Major hepatectomy was performed in 69 (35.9 %) SCLR patients and 774 (41.7 %) LR patients (p00.12). Median adjusted operation time (SCLR: 273 min, 95 % CI: 253-295; CR: 172, CI: 168-177; LR: 222, CI: 217-228; p<0.001) and median adjusted length of hospital stay (SCLR: 9.5 days, CI: 8.8-10.4; CR: 8.1, CI: 7.9-8.3; LR: 6.4, CI: 6.3-6.6; p<0.001) were longer for SCLR compared to CR and LR. Adjusted predicted risks for at least one postoperative complication were higher in SCLR (36.3 %) than in CR (26.6 %) and LR (19.8 %) (p<0.003), mostly due to infectious/ cardiopulmonary issues. Discussion In SCLR patients, the risk of 30-day adverse outcomes is higher, and median operation time as well as length of hospital stay is longer compared to CR and LR patients. However, the expected combined morbidities of staged procedures though likely favor SCLR in carefully selected patients undergoing even complex hepatic and colorectal resections and should be considered.

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“…Practicar la I N V E S T I G A C I Ó N cirugía colónica y hepática diferidamente o resecar las metástasis en forma simultánea a la cirugía colorrectal. La cirugía en 2 tiempos es la opción que se ha preferido en muchos centros, aunque recientemente han aparecido grupos que proponen realizar la cirugía en forma simultánea [26][27][28][29] . Esta serie presenta 32% de resecciones simultá-neas.…”

Section: Discussionunclassified

Resultados del tratamiento quirúrgico de las metástasis hepáticas por cáncer colorrectal

et al. 2009

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Outcome of surgical treatment of liver metastasis from colorectal cancer 1 (1990-1997) and period 2 (1998-2007 (77% and 55%, respectively, p =0.04), without an increase in complications (35% and 34%, respectively; p =ns), but with a better five years survival (45% and 21%, respectively, p =0.04). Conclusions: Five years survival for excision of liver metastatic colorectal cancer in our center is similar to that reported abroad. During the second period there has been a trend toward more extensive resections which was associated with a better survival, without an increase in complications or mortality (Rev Méd Chile 2009; 137: 487-96).

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Simultaneous Resections of Colorectal Cancer and Synchronous Liver Metastases: A Multi-institutional Analysis

Abstract: Simultaneous colorectal and minor hepatic resections are safe and should be performed for most patients with SCRLM. Due to increased risk of severe morbidity, caution should be exercised before performing simultaneous colorectal and major hepatic resections.

Cited by 381 publications

References 34 publications

Reliability of a Complication Classification System for Orthopaedic Surgery

Reliability of a Complication Classification System for Orthopaedic Surgery

Is There a Role for Simultaneous Hepatic and Colorectal Resections? A Contemporary View from NSQIP

Resultados del tratamiento quirúrgico de las metástasis hepáticas por cáncer colorrectal

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