Detours on the Road to Recovery: What Factors Delay Readiness to Return to Intended Oncologic Therapy (RIOT) After Liver Resection for Malignancy?
Hepatectomy
Liver surgery
Multidisciplinary cancer care
Postoperative outcomes
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
21
08
2018
accepted:
08
02
2019
pubmed:
28
2
2019
medline:
26
8
2020
entrez:
28
2
2019
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 30809785
doi: 10.1007/s11605-019-04165-5
pii: 10.1007/s11605-019-04165-5
pmc: PMC6900935
mid: NIHMS1058812
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2362-2371Subventions
Organisme : NCI NIH HHS
ID : P30 CA016672
Pays : United States
Organisme : NCI NIH HHS
ID : T32 CA009599
Pays : United States
Références
Ann Surg Oncol. 2007 Oct;14(10):2798-806
pubmed: 17632760
Surgery. 2011 May;149(5):680-8
pubmed: 21316725
Am J Clin Oncol. 1982 Dec;5(6):649-55
pubmed: 7165009
Cancer. 1999 Mar 1;85(5):1186-96
pubmed: 10091805
Br J Surg. 2014 Feb;101(3):159-70
pubmed: 24469616
Cancer. 2000 Oct 1;89(7):1634-46
pubmed: 11013380
J Clin Oncol. 2010 Sep 1;28(25):4013-7
pubmed: 20660825
Int J Surg. 2016 Dec;36(Pt A):274-282
pubmed: 27840308
J Am Coll Surg. 2010 Mar;210(3):286-98
pubmed: 20193891
Med Care. 2014 Feb;52(2 Suppl 1):S66-73
pubmed: 24430269
Presse Med. 1954 May 5;62(33):709-12
pubmed: 13177441
Ann Surg Oncol. 2016 Jan;23(1):335-42
pubmed: 26152275
JAMA Surg. 2017 Mar 1;152(3):292-298
pubmed: 28097305
Medicine (Baltimore). 2015 Jul;94(29):e1225
pubmed: 26200648
Pain. 1995 May;61(2):277-84
pubmed: 7659438
HPB (Oxford). 2014 Aug;16(8):699-706
pubmed: 24661306
JAMA Surg. 2015 May;150(5):390-5
pubmed: 25738898
J Surg Oncol. 2017 Oct;116(5):570-577
pubmed: 28873504
Onco Targets Ther. 2016 Oct 21;9:6529-6537
pubmed: 27799800
Langenbecks Arch Surg. 2015 Feb;400(2):167-81
pubmed: 25681239
Springerplus. 2016 Feb 29;5:207
pubmed: 27026903
Ann Surg. 2018 Jul;268(1):19-21
pubmed: 29727325
J Am Coll Surg. 2015 Dec;221(6):1023-30.e1-2
pubmed: 26611799
Oncotarget. 2017 Feb 14;8(7):11778-11787
pubmed: 28052031
World J Surg. 2017 Apr;41(4):899-913
pubmed: 27822725
Surg Infect (Larchmt). 2016 Dec;17(6):656-664
pubmed: 27676639
Hepatobiliary Surg Nutr. 2015 Feb;4(1):59-71
pubmed: 25713805
Cancer Nurs. 2019 Jul/Aug;42(4):E47-E53
pubmed: 29933304
Antimicrob Resist Infect Control. 2017 May 12;6:45
pubmed: 28507731
Ann Surg. 2018 Jan;267(1):57-65
pubmed: 28437313
Cancer. 2010 Apr 15;116(8):2053-63
pubmed: 20166216
Int Anesthesiol Clin. 2016 Fall;54(4):e33-46
pubmed: 27623128
J Surg Oncol. 2014 Aug;110(2):107-14
pubmed: 24846705