EP700 - The Impact of Operative Time on Morbidity in Synchronous Colorectal Cancer and Liver Metastasis Resections

Monday, May 12, 2025

10:53 AM – 10:58 AM PT

ePoster Presenter(s)

RS

Reena S. Suresh, MBCHB

Research Fellow
Johns Hopkins Medical Institutions
Johns Hopkins School of Medicine
Baltimore, Maryland, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Sophia Diaz, MD, MSE (she/her/hers)

Surgical Resident Physician
Johns Hopkins University
Baltimore, MD, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
MS

Miloslawa Stem, MS

Research Associate
Johns Hopkins School of Medicine
Balitmore, Maryland, United States

Disclosure information not submitted.
Lawrence B. Brown, MD, MPH, MHS (he/him/his)

General Surgery Resident
The Johns Hopkins Hospital
Baltimore, Maryland, United States

Disclosure information not submitted.
Michael S. Consul, n/a (he/him/his)

Medical Student
Johns Hopkins University School of Medicine
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States

Disclosure information not submitted.
Haniee Chung, MD, FACS

Assistant Professor
Johns Hopkins School of Medicine
Baltimore, MD, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
AB

Andrea C. Bafford, MD

Associate Professor of Clinical Surgery PAR
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

Alodia Gabre-Kidan, MD, MPH

Assistant Professor of Surgery
Johns Hopkins School of Medicine
Johns Hopkins School of Medicine
Towson, MD, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Reena S. Suresh, MBCHB: This individual has no financial relationships with ineligible companies.

Sophia Diaz, MD, MSE: This individual has no financial relationships with ineligible companies.

Haniee Chung, MD, FACS: This individual has no financial relationships with ineligible companies.

Andrea C. Bafford, MD: This individual has no financial relationships with ineligible companies.

Alodia Gabre-Kidan, MD, MPH: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Prolonged operative time during synchronous resections for colorectal cancer (CRC) with liver metastases (CRLM) may contribute to increased post-operative morbidity. Understanding the association between operative time and morbidity is critical for optimizing surgical planning and improving patient care. This study aims to evaluate the relationship between operative time and 30-day morbidity in synchronous CRLM resections.

Methods/Interventions: A retrospective analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program Database from 2013 to 2022. Patients ≥18 years old who underwent synchronous CRC primary tumor and CRLM resections were included. Operative time was categorized into intervals ( < 5, 5-6, 6-7, 7-8, ≥8 hours), and multivariable logistic regression was performed to determine the association between operative time and the primary outcome of 30-day post-operative morbidity.

Results/Outcomes: Among 2,306 patients, 58.1% were male and 64.7% were of white race. The median age was 60 years (interquartile range [IQR]: 50-69). With regards to operative approach, 5.0% of procedures were completed robotically, 15.6% laparoscopically and 79.4% were open. The median operative time across all patients was 306 minutes (IQR: 227-392). When stratified by operative approach, the median time was 372 minutes for robotic (IQR: 293-480), 318.5 minutes for laparoscopic (IQR: 216-406.5) and 301 minutes for open (IQR: 226-383). The 30-day overall morbidity rate for all patients was 36.6% (29.7% for minimally invasive surgeries [MIS] and 38.4% for open), while the serious morbidity rate was 20.1%. Notable complications included post-operative shock/sepsis (7.4%), organ space surgical site infection (12.2%) and bleeding requiring transfusion (17.5%). Multivariable logistic regression analysis revealed that the odds of experiencing 30-day morbidity were greater for operative durations exceeding 6 hours (OR: 1.43; 95% CI: 1.09-1.90; p=0.009) and continued to rise for surgeries lasting 8 or more hours (OR: 2.42; 95% CI; 1.77-3.30; p< 0.001) (Table). Further analyses stratified by operative approach demonstrated that MIS cases had greater odds of morbidity beginning at operative times of 8 hours or more (OR: 2.56; 95% CI: 1.39-4.75; p=0.003). Conversely, open resections had a significant increase in morbidity starting at 6 hours (OR: 1.37; 95% CI: 1.01-1.86; p=0.040) which continued to rise for durations ≥8 hours (OR: 2.28; 95% CI; 1.59-3.27; p< 0.001). Additional factors significantly associated with overall morbidity included age ≥70 years, ASA classification III/IV, frailty, smoking, pre-operative steroid requirement, planned open approach, and high-risk procedures.

Conclusion/Discussion: Our analyses indicate that at 6 hours, the risk of 30-day post-operative morbidity increases for combined CRC and CRLM cases. Furthermore, when comparing surgical approaches, a 2-hour difference in risk threshold was observed with the risk rising earlier for open procedures compared to MIS procedures. These findings highlight the importance of critically evaluating and managing operative duration and surgical approach to optimize post-operative outcomes in this patient population.