期刊
JOURNAL OF GASTROINTESTINAL SURGERY
卷 23, 期 12, 页码 2362-2371出版社
SPRINGER
DOI: 10.1007/s11605-019-04165-5
关键词
Liver surgery; Postoperative outcomes; Multidisciplinary cancer care; Hepatectomy
资金
- National Institutes of Health [T32CA009599]
- MD Anderson Cancer Center [P30 CA016672]
Background Poor recovery after oncologic hepatic resection delays Return to Intended Oncologic Therapy (RIOT) and shortens survival. In order to identify at-risk patients, this study was designed to determine which psychosocial and perioperative factors are associated with delayed RIOT readiness. Methods A prospectively maintained database was queried to identify consecutive patients undergoing hepatectomy for malignancy from 2015 to 2017. Perioperative factors were compared between patients with early (<= 28 postoperative days) vs. delayed (> 28 postoperative days) clearance to RIOT. Univariate analysis and multivariable logistic regression were performed. Results Of 114 patients, 76 patients (67%) had an open surgical approach, 32 (28%) had a major hepatectomy, and 6 (5%) had a major complication, with no mortalities. Eighty-two patients (72%) had early and 32 patients (28%) had delayed RIOT readiness. Patients with high preoperative symptom burden were more likely to have delayed RIOT readiness (OR 3.1, 95% CI 1.1-8.4, p = 0.024). On multivariable analysis, open surgical approach (OR 6.9, 95% CI 1.4-34.7, p = 0.018), length of stay > 5 days (OR 3.6, 95% CI 1.4-9.4, p = 0.010), and any complication (OR 3.4, 95% CI 1.1-10.7, p = 0.033) were associated with delayed RIOT readiness. Postoperative factors associated with delayed RIOT readiness included nutritional and wound-healing parameters. Conclusions This study highlights the previously under-described importance of preoperative patient symptom burden on delayed postoperative recovery. As a cancer patient's return to oncologic therapy after hepatectomy has a substantial impact on survival, it is critical to adhere to enhanced recovery principles and address all other modifiable factors that delay recovery.
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