Clinical outcomes of oncologic gastrointestinal resections in patients with cirrhosis

Authors

  • Avo Artinyan MD, MS,

    Corresponding author
    1. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
    2. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
    • Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, OCL 112, Houston, TX 77005

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    • Fax: (713) 794-7352

  • Christy L. Marshall MD,

    1. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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  • Courtney J. Balentine MD,

    1. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
    2. Houston Veterans Affairs Health Services Research and Development Service Center of Excellence, Houston, Texas
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  • Daniel Albo MD, PhD,

    1. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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  • Sonia T. Orcutt MD,

    1. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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  • Samir S. Awad MD,

    1. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
    2. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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  • David H. Berger MD, MHCM,

    1. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
    2. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
    3. Houston Veterans Affairs Health Services Research and Development Service Center of Excellence, Houston, Texas
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  • Daniel A. Anaya MD

    1. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
    2. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
    3. Houston Veterans Affairs Health Services Research and Development Service Center of Excellence, Houston, Texas
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  • The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Abstract

BACKGROUND:

Cirrhosis is a risk factor for postoperative morbidity and mortality after general surgical procedures. However, the impact of cirrhosis on outcomes of surgical resection for gastrointestinal (GI) malignancies has not been described. The authors' objective was to characterize early postoperative and transitional outcomes in cirrhotic patients undergoing GI cancer surgery.

METHODS:

Query of the National Inpatient Sample Database (2005-2008) identified 106,729 patients who underwent resection for GI malignancy; 1479 (1.4%) had cirrhosis. The association of cirrhosis with postoperative outcomes was examined. The primary outcome measure was in-hospital mortality. Secondary outcomes included length-of-stay (LOS) and discharge to long-term care facility (LTCF).

RESULTS:

Cirrhotic patients had higher risk of in-hospital mortality (8.9% vs 2.8%, P < .001), longer LOS (11.5 ± 0.26 vs 10.0 ± 0.03 days, P < .001), and higher rate of discharge to LTCF (19.0% vs 15.7%, P < .001). Mortality was highest in patients with moderate to severe liver dysfunction (21.5% vs 6.5%, P < .001). On multivariate analysis, cirrhosis was an independent predictor of in-hospital mortality (odds ratio [OR], 3.0; 95% confidence interval [CI] 2.5-3.7) and nonhome discharge (OR, 1.7; 95% CI, 1.4-2.0). In cirrhotic patients, moderate to severe liver dysfunction was the only independent predictor of in-hospital mortality (OR, 4.03; 95% CI, 2.7-5.9), but did not predict discharge disposition.

CONCLUSIONS:

Resection of GI malignancy in cirrhotics is associated with poor early postoperative and transitional outcomes, with severity of liver disease being the primary determinant of postoperative mortality. These data suggest that GI cancer operations can be performed safely in well-selected cirrhotic patients with mild liver dysfunction. Cancer 2012;3494–3500. © 2011 American Cancer Society.

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