Incidence And Predictors Of Textbook Outcome After Simultaneous Liver And Rectal Surgeries For Stage Iv Rectal Cancer.

Abstract

AIM\nTextbook 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.\n\n\nMETHODS\nIn total, 256 patients who underwent simultaneous liver and rectal surgery for stage IV rectal cancer between January 2004 and August 2019 at five tertiary centers were enrolled. TO was defined as a lack of complication, prolonged length of stay, readmission, and death.\n\n\nRESULTS\nMortality 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].\n\n\nCONCLUSION\nTO was achieved in 6 of 10 patients undergoing simultaneous resections for rectal cancer and liver metastases. Achieving 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.