The Impact of Operative Time on Morbidity in Synchronous Colorectal Cancer and Liver Metastasis Resections

摘要

BACKGROUND: Prolonged operative time during synchronous colorectal cancer with liver metastases resections may increase postoperative morbidity. OBJECTIVE: To evaluate the relationship between operative time and 30-day morbidity in synchronous colorectal cancer with liver metastases resections, and to identify the optimal operative time cutoff that may inform the decision to pursue a staged surgical approach. DESIGN: Retrospective cohort study. SETTING: Data were collected from the American College of Surgeons National Surgical Quality Improvement Program database for the years 2013 through 2022. PATIENTS: Adult patients undergoing simultaneous colorectal cancer and liver metastasis resection were included. MAIN OUTCOME MEASURES: Rates of 30-day overall and serious morbidity. RESULTS: Among 2306 patients, 58.1% were men, 64.7% were of White race, and the median age was 60 years. Most procedures were open (79.4%). The median operative time was 306 minutes (372 for robotic, 318.5 for laparoscopic, and 301 minutes for open surgeries). The 30-day overall morbidity rate was 36.6% (29.7% for minimally invasive surgeries and 38.4% for open surgeries), with serious morbidity at 20.1%. Based on the continuous (Youden Index) and binary (area under the curve) exploration of optimal operative time cutoff, the following operative time categories were created: <5, 5 to 6, 6 to 7, 7 to 8, and ≥8 hours. Multivariable analysis revealed increased risk of morbidity for operative durations >6 hours (OR 1.48; 95% CI, 1.13-1.96; p = 0.004), which rose with rising operative times. Minimally invasive cases had an increased risk of morbidity starting at ≥8 hours, whereas open resections demonstrated increased risk starting at 6 hours. Additional factors linked with morbidity included age 70 years or older, ASA classification III or IV, functional dependence, smoking, steroid use, and open approach. LIMITATIONS: Retrospective design and limitations of data from the American College of Surgeons National Surgical Quality Improvement Program database. CONCLUSIONS: This study demonstrates that 30-day morbidity increases after 6 hours in colorectal cancer with liver metastases resections, with a 2-hour difference in risk threshold between minimally invasive surgeries and open cases. These results highlight the need to manage operative duration and approach to improve outcomes for these patients. See Video Abstract . EL IMPACTO DEL TIEMPO QUIRRGICO EN LA MORBILIDAD EN RESECCIONES SINCRNICAS DE CNCER COLORRECTAL Y METSTASIS HEPTICAS: ANTECEDENTES:El tiempo quirúrgico prolongado durante la resección de cáncer colorrectal sincrónico con metástasis hepáticas puede aumentar la morbilidad posoperatoria.OBJETIVO:Evaluar la relación entre el tiempo quirúrgico y la morbilidad a los 30 días en la resección de cáncer colorrectal sincrónico con metástasis hepáticas, e identificar el tiempo quirúrgico óptimo que pueda servir de base para decidir si se debe seguir un enfoque quirúrgico por etapas.DISEÑO:Estudio de cohorte retrospectivo.ENTORNO:Los datos se recopilaron de la base de datos del Programa Nacional de Mejora de la Calidad Quirúrgica del Colegio Americano de Cirujanos para los años 2013 a 2022.PRINCIPAL MEDIDA DE RESULTADO:Tasas de morbilidad general y grave a los 30 días.RESULTADOS:De los 2306 pacientes, el 58,1 % eran hombres, el 64,7 % eran blancos y la mediana de edad era de 60 años. La mayoría de las intervenciones fueron abiertas (79,4 %). La mediana del tiempo quirúrgico fue de 306 minutos (372 para la cirugía robótica, 318,5 para la laparoscópica y 301 minutos para la abierta). La tasa de morbilidad global a los 30 días fue del 36,6 % (29,7 % para las cirugías mínimamente invasivas y 38,4 % para las abiertas), con una morbilidad grave del 20,1 %. A partir de la exploración continua (índice de Youden) y binaria (área bajo la curva) del tiempo quirúrgico óptimo, se crearon las siguientes categorías de tiempo quirúrgico: <5 horas, 5-6 horas, 6-7 horas, 7-8