Infectious complications in combined colon resection and ablation of colorectal liver metastases

Cathryn A. Doughtie, Jacob D. Edwards, Prejesh Philips, Steven Agle, Charles R. Scoggins, Kelly M. McMasters, Robert C G Martin

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background The multifactorial incidence of infectious complications carries considerable consequences for patients undergoing more extensive surgery with intent to cure metastatic colorectal cancer. Advances in ablation techniques have emerged as an efficacious method in regional control for liver metastasis from colorectal cancer; however, the degree of increased risk of infectious complications when ablation is performed in combination with colon resection has not been defined. Methods An analysis of a single institution's prospective database from August 1998 to December 2012 was performed for patients undergoing colon resection. Patients were stratified into a colon resection combined with either microwave ablation (MWA) or radiofrequency ablation (RFA) compared to a colon resection only group. Variables included baseline clinicopathologic data, type of operation, complication grade, and infectious outcome. Fisher exact test, Student t test, and analysis of variance were used to detect significance levels of P values less than.05. Results A total of 132 patients with colon cancer of various origins were identified. The group of colon resection combined with RFA and/or MWA was 53 patients (34 male:19 female) and was compared to a matched group of 79 patients (40 male:39 female) who underwent colon resection alone. Median age (58 vs 60 years; P =.209), complication rate (60.7% vs 62.5%; P =.722), infection rate (28.7% vs 35.4%; P = 1.0), mean blood loss (352.7 vs 468.4 mL; P =.452), mean blood transfused (1.36 vs.76 U; P =.247), and receipt of neoadjuvant chemotherapy (47.1% vs 51.85%; P =.724) were all similar between the ablation group and colon only group, respectively. Transfusion rate was higher in the ablation group (39.6% vs 18.9%; P =.016). Overall complication rate was 60.6%, with 32.6% infections. One mortality was observed in each group. High-grade (grade, III to V) complications (35.8% vs 18.9%; P =.0112) and liver-specific complications (n = 4; P =.024) were significantly increased in the combined ablation group. Conclusions Combining MWA or RFA techniques with colon resection for liver metastasis appears to have similar infectious and overall complication rates when compared to performing an isolated resection of the primary colon cancer alone, although there may be a higher degree of complication seen in the more aggressive approach for curative intent in patients with colorectal liver metastasis.

Original languageEnglish (US)
Pages (from-to)1185-1191
Number of pages7
JournalAmerican Journal of Surgery
Volume210
Issue number6
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

Fingerprint

Colon
Neoplasm Metastasis
Liver
Microwaves
Ablation Techniques
Colonic Neoplasms
Colorectal Neoplasms
Infection
Analysis of Variance
Research Design
Databases
Students
Drug Therapy
Mortality
Incidence

Keywords

  • Colorectal liver metastasis
  • Infection
  • Microwave ablation
  • Radiofrequency ablation

ASJC Scopus subject areas

  • Surgery

Cite this

Doughtie, C. A., Edwards, J. D., Philips, P., Agle, S., Scoggins, C. R., McMasters, K. M., & Martin, R. C. G. (2015). Infectious complications in combined colon resection and ablation of colorectal liver metastases. American Journal of Surgery, 210(6), 1185-1191. https://doi.org/10.1016/j.amjsurg.2015.07.012

Infectious complications in combined colon resection and ablation of colorectal liver metastases. / Doughtie, Cathryn A.; Edwards, Jacob D.; Philips, Prejesh; Agle, Steven; Scoggins, Charles R.; McMasters, Kelly M.; Martin, Robert C G.

In: American Journal of Surgery, Vol. 210, No. 6, 01.12.2015, p. 1185-1191.

Research output: Contribution to journalArticle

Doughtie, CA, Edwards, JD, Philips, P, Agle, S, Scoggins, CR, McMasters, KM & Martin, RCG 2015, 'Infectious complications in combined colon resection and ablation of colorectal liver metastases', American Journal of Surgery, vol. 210, no. 6, pp. 1185-1191. https://doi.org/10.1016/j.amjsurg.2015.07.012
Doughtie, Cathryn A. ; Edwards, Jacob D. ; Philips, Prejesh ; Agle, Steven ; Scoggins, Charles R. ; McMasters, Kelly M. ; Martin, Robert C G. / Infectious complications in combined colon resection and ablation of colorectal liver metastases. In: American Journal of Surgery. 2015 ; Vol. 210, No. 6. pp. 1185-1191.
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abstract = "Background The multifactorial incidence of infectious complications carries considerable consequences for patients undergoing more extensive surgery with intent to cure metastatic colorectal cancer. Advances in ablation techniques have emerged as an efficacious method in regional control for liver metastasis from colorectal cancer; however, the degree of increased risk of infectious complications when ablation is performed in combination with colon resection has not been defined. Methods An analysis of a single institution's prospective database from August 1998 to December 2012 was performed for patients undergoing colon resection. Patients were stratified into a colon resection combined with either microwave ablation (MWA) or radiofrequency ablation (RFA) compared to a colon resection only group. Variables included baseline clinicopathologic data, type of operation, complication grade, and infectious outcome. Fisher exact test, Student t test, and analysis of variance were used to detect significance levels of P values less than.05. Results A total of 132 patients with colon cancer of various origins were identified. The group of colon resection combined with RFA and/or MWA was 53 patients (34 male:19 female) and was compared to a matched group of 79 patients (40 male:39 female) who underwent colon resection alone. Median age (58 vs 60 years; P =.209), complication rate (60.7{\%} vs 62.5{\%}; P =.722), infection rate (28.7{\%} vs 35.4{\%}; P = 1.0), mean blood loss (352.7 vs 468.4 mL; P =.452), mean blood transfused (1.36 vs.76 U; P =.247), and receipt of neoadjuvant chemotherapy (47.1{\%} vs 51.85{\%}; P =.724) were all similar between the ablation group and colon only group, respectively. Transfusion rate was higher in the ablation group (39.6{\%} vs 18.9{\%}; P =.016). Overall complication rate was 60.6{\%}, with 32.6{\%} infections. One mortality was observed in each group. High-grade (grade, III to V) complications (35.8{\%} vs 18.9{\%}; P =.0112) and liver-specific complications (n = 4; P =.024) were significantly increased in the combined ablation group. Conclusions Combining MWA or RFA techniques with colon resection for liver metastasis appears to have similar infectious and overall complication rates when compared to performing an isolated resection of the primary colon cancer alone, although there may be a higher degree of complication seen in the more aggressive approach for curative intent in patients with colorectal liver metastasis.",
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AU - Edwards, Jacob D.

AU - Philips, Prejesh

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AU - Scoggins, Charles R.

AU - McMasters, Kelly M.

AU - Martin, Robert C G

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N2 - Background The multifactorial incidence of infectious complications carries considerable consequences for patients undergoing more extensive surgery with intent to cure metastatic colorectal cancer. Advances in ablation techniques have emerged as an efficacious method in regional control for liver metastasis from colorectal cancer; however, the degree of increased risk of infectious complications when ablation is performed in combination with colon resection has not been defined. Methods An analysis of a single institution's prospective database from August 1998 to December 2012 was performed for patients undergoing colon resection. Patients were stratified into a colon resection combined with either microwave ablation (MWA) or radiofrequency ablation (RFA) compared to a colon resection only group. Variables included baseline clinicopathologic data, type of operation, complication grade, and infectious outcome. Fisher exact test, Student t test, and analysis of variance were used to detect significance levels of P values less than.05. Results A total of 132 patients with colon cancer of various origins were identified. The group of colon resection combined with RFA and/or MWA was 53 patients (34 male:19 female) and was compared to a matched group of 79 patients (40 male:39 female) who underwent colon resection alone. Median age (58 vs 60 years; P =.209), complication rate (60.7% vs 62.5%; P =.722), infection rate (28.7% vs 35.4%; P = 1.0), mean blood loss (352.7 vs 468.4 mL; P =.452), mean blood transfused (1.36 vs.76 U; P =.247), and receipt of neoadjuvant chemotherapy (47.1% vs 51.85%; P =.724) were all similar between the ablation group and colon only group, respectively. Transfusion rate was higher in the ablation group (39.6% vs 18.9%; P =.016). Overall complication rate was 60.6%, with 32.6% infections. One mortality was observed in each group. High-grade (grade, III to V) complications (35.8% vs 18.9%; P =.0112) and liver-specific complications (n = 4; P =.024) were significantly increased in the combined ablation group. Conclusions Combining MWA or RFA techniques with colon resection for liver metastasis appears to have similar infectious and overall complication rates when compared to performing an isolated resection of the primary colon cancer alone, although there may be a higher degree of complication seen in the more aggressive approach for curative intent in patients with colorectal liver metastasis.

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