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. 2022 Jan;24(1):50-58.
doi: 10.1111/codi.15912. Epub 2021 Sep 24.

Incidence and predictors of textbook outcome after simultaneous liver and rectal surgeries for Stage IV rectal cancer

Nadia Russolillo  1 , Valentina Gentile  1 , Francesca Ratti  2 , Francesco Ardito  3 , Matteo Serenari  4 , Raffaele Lombardi  5 , Elio Jovine  5 , Matteo Cescon  4 , Felice Giuliante  3 , Luca Aldrighetti  2 , Alessandro Ferrero  1
Affiliations

Incidence and predictors of textbook outcome after simultaneous liver and rectal surgeries for Stage IV rectal cancer

Nadia Russolillo et al. Colorectal Dis. 2022 Jan.

Abstract

Aim: Textbook outcome (TO) is a new surgical quality measure that combines structure, process and surgical outcomes into a single element. Our study aimed to determine the incidence of TO after simultaneous rectal and liver surgery and to use the achievement of TO as a tool to identify the best candidates for these complex procedures.

Methods: In total, 256 patients who underwent simultaneous liver and rectal surgery for Stage IV rectal cancer between January 2004 and August 2019 at five tertiary centres were enrolled. TO was defined as a lack of complication, prolonged length of stay, readmission and death.

Results: Mortality rate at 90 days and major morbidity rate were 2.3% and 15.6%, respectively. An overall TO was achieved in 59% of the patients, which is associated with significantly improved overall (median TO 86.3 months vs. no TO 37.4 months) and disease-free (median TO 70.6 months vs. no TO 24.9 months) survival. On multivariate analysis the presence of multi-comorbidities (OR 3.073) was associated with a reduced likelihood of achieving TO. Left lateral sectionectomy/limited resection was a protective factor (OR 0.416).

Conclusion: TO was achieved in six of 10 patients undergoing simultaneous resections for rectal cancer and liver metastases. Achieving a TO is strongly associated with improved long-term survival. The best candidates for these procedures were patients without multiple comorbidities and those treated with left lateral sectionectomy/limited resection.

Keywords: liver resection; rectal cancer; simultaneous rectal and liver surgery; synchronous liver metastases; textbook outcome.

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References

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