Evaluation of the American College of Surgeons risk calculator in hepatectomy for metastatic colorectal cancer in a...

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Health services research

Background:

• Hepatectomy is a critical treatment for liver metastasis from colorectal cancer (CRC).
• Accurate prediction of postoperative outcomes is essential for patient management and resource allocation.
• The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) calculator is a widely used tool for predicting surgical outcomes.

Purpose of the Study:

• To evaluate the predictive accuracy of the ACS-NSQIP calculator for postoperative outcomes in patients undergoing hepatectomy for CRC liver metastasis.
• To assess the calculator's performance in a Southeast Asian population.

Main Methods:

• A retrospective review of 166 patients who underwent hepatectomy for CRC liver metastasis between 2017 and 2022.
• Comparison of predicted outcomes from the ACS-NSQIP calculator with actual patient outcomes.
• Statistical analysis using receiver operating characteristic (ROC) curves, area under the curve (AUC), and Brier scores.

Main Results:

• The ACS-NSQIP calculator demonstrated good accuracy (AUC > 0.70) in predicting most postoperative complications.
• Satisfactory performance was observed for predicting readmission (AUC = 0.818) and reoperation (AUC = 0.945).
• The calculator accurately predicted length of stay (LOS) (AUC = 0.909), with predicted LOS (5.9 days) closely matching actual LOS (5.0 days).
• Prediction accuracy for surgical site infection was less precise (AUC = 0.678).

Conclusions:

• The ACS-NSQIP calculator shows generally accurate predictive capabilities for 30-day postoperative outcomes in hepatectomy patients with CRC liver metastasis.
• The tool can be a valuable aid in clinical decision-making and patient counseling for this specific population.
• Further validation may be needed for specific complications like surgical site infections.