Clinical outcomes of oncologic gastrointestinal resections in patients with cirrhosis

Avo Artinyan, Christy L. Marshall, Courtney J. Balentine, Daniel Albo, Sonia T. Orcutt, Samir S. Awad, David H. Berger, Daniel A. Anaya

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)3494-3500
Number of pages7
JournalCancer
Volume118
Issue number14
DOIs
StatePublished - Jul 15 2012
Externally publishedYes

Fingerprint

Fibrosis
Hospital Mortality
Liver Diseases
Gastrointestinal Neoplasms
Odds Ratio
Long-Term Care
Confidence Intervals
Mortality
Length of Stay
Neoplasms
Inpatients
Multivariate Analysis
Outcome Assessment (Health Care)
Databases
Morbidity

Keywords

  • cirrhosis
  • gastrointestinal malignancy
  • oncologic resection
  • postoperative outcomes
  • transitional outcomes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Artinyan, A., Marshall, C. L., Balentine, C. J., Albo, D., Orcutt, S. T., Awad, S. S., ... Anaya, D. A. (2012). Clinical outcomes of oncologic gastrointestinal resections in patients with cirrhosis. Cancer, 118(14), 3494-3500. https://doi.org/10.1002/cncr.26682

Clinical outcomes of oncologic gastrointestinal resections in patients with cirrhosis. / Artinyan, Avo; Marshall, Christy L.; Balentine, Courtney J.; Albo, Daniel; Orcutt, Sonia T.; Awad, Samir S.; Berger, David H.; Anaya, Daniel A.

In: Cancer, Vol. 118, No. 14, 15.07.2012, p. 3494-3500.

Research output: Contribution to journalArticle

Artinyan, A, Marshall, CL, Balentine, CJ, Albo, D, Orcutt, ST, Awad, SS, Berger, DH & Anaya, DA 2012, 'Clinical outcomes of oncologic gastrointestinal resections in patients with cirrhosis', Cancer, vol. 118, no. 14, pp. 3494-3500. https://doi.org/10.1002/cncr.26682
Artinyan A, Marshall CL, Balentine CJ, Albo D, Orcutt ST, Awad SS et al. Clinical outcomes of oncologic gastrointestinal resections in patients with cirrhosis. Cancer. 2012 Jul 15;118(14):3494-3500. https://doi.org/10.1002/cncr.26682
Artinyan, Avo ; Marshall, Christy L. ; Balentine, Courtney J. ; Albo, Daniel ; Orcutt, Sonia T. ; Awad, Samir S. ; Berger, David H. ; Anaya, Daniel A. / Clinical outcomes of oncologic gastrointestinal resections in patients with cirrhosis. In: Cancer. 2012 ; Vol. 118, No. 14. pp. 3494-3500.
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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.",
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N2 - 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.

AB - 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.

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