Retrospective study of one-year mortality after hepatectomy: defining a novel quality metric

Owing to better technique and perioperative care, 30- and 90-day mortality after hepatectomy has improved. However, little is known about survival in the first year after hepatectomy. A retrospective study at Memorial Sloan Kettering Cancer Center (New York) included 6169 patients undergoing hepatectomy (54% for colorectal cancer liver metastases, CRLM). The 1-year survival rate was 89.9% (95% CI 89.1-90.7). For patients who survived yo 90 days, the probability of survival until 1 years was 92% (95% CI 91.9-92.5). In the CRLM subset, the 1-year death rate was 7.6% (95% CI 6.7-8.6). Factors associated with death at 1 year in the CRLM subset were major complications (17% versus 5%; OR 2.94; p<0.001), 1-year recurrence, (111% versus 5%; OR 2.78; pxtagstartz0.001), 4 or more liver lesions (12% versus 7%; OR 2.12; p<0.001), and hepatitis B or C (20% versus 7%; OR 3.47; p=0.012). The authors conclude that the 1-year mortality after hepatectomy is substantial. Unlike the 30- and 90 day mortality, which capture technical and perioperative causes of death, 1-year mortality may serve as a moren comprehensive postoperative outcome, more broadly capturing postsurgical events and disease progression.