BACKGROUND: Rates of metastatectomy vary among patients with liver-only metastatic colorectal cancer (MCRC). This study describe predictors of referral to a hepatobiliary surgeon (HBS) and hepatic resection in a population-based setting. MATERIALS AND METHODS: Patients referred to the British Columbia Cancer Agency (BCCA) with synchronous or relapsed MCRC isolated to the liver in 2002-2004 were identified. Classification of tumor burden as "high" or "low" was based on prognostic features defined by LiverMetSurvery registry. Metastases larger than 5 cm, bilobar, or more than 3 metastases were classified as high tumor burden. Multivariate logistic regression models were used to identify predictors of HBS referral and subsequent metastatectomy. Overall survival was calculated by the Kaplan-Meier method. RESULTS: Of 618 patients with isolated hepatic metastasis, 148 (24%) were referred to a HBS and 99 (16%) underwent resection. Advanced age was the most common reason for not referring 64 patients (10%) with ECOG performance status 0/1 and low tumor burden. In multivariate analysis, variables associated with referral were younger age (P < .001), ECOG performance status 0/1 (P < .002), chemotherapy for metastatic disease (P = .007), 1-3 metastasis (P < .001), and unilobar disease (P < .001). Median patient survival was 0.99 years (95% confidence interval [95% CI], 0.89-1.10 years) among nonreferred, 1.83 years (95% CI, 1.37-2.31 years) if referred but not resected, and 3.85 years (95% CI, 2.90-4.80 years) if resected. CONCLUSION: A significant proportion of patients are not referred to a HBS because of advanced chronological age. Resection of hepatic metastases was associated with improved overall survival irrespective of initial tumor burden.
BACKGROUND: Rates of metastatectomy vary among patients with liver-only metastatic colorectal cancer (MCRC). This study describe predictors of referral to a hepatobiliary surgeon (HBS) and hepatic resection in a population-based setting. MATERIALS AND METHODS:Patients referred to the British Columbia Cancer Agency (BCCA) with synchronous or relapsed MCRC isolated to the liver in 2002-2004 were identified. Classification of tumor burden as "high" or "low" was based on prognostic features defined by LiverMetSurvery registry. Metastases larger than 5 cm, bilobar, or more than 3 metastases were classified as high tumor burden. Multivariate logistic regression models were used to identify predictors of HBS referral and subsequent metastatectomy. Overall survival was calculated by the Kaplan-Meier method. RESULTS: Of 618 patients with isolated hepatic metastasis, 148 (24%) were referred to a HBS and 99 (16%) underwent resection. Advanced age was the most common reason for not referring 64 patients (10%) with ECOG performance status 0/1 and low tumor burden. In multivariate analysis, variables associated with referral were younger age (P < .001), ECOG performance status 0/1 (P < .002), chemotherapy for metastatic disease (P = .007), 1-3 metastasis (P < .001), and unilobar disease (P < .001). Median patient survival was 0.99 years (95% confidence interval [95% CI], 0.89-1.10 years) among nonreferred, 1.83 years (95% CI, 1.37-2.31 years) if referred but not resected, and 3.85 years (95% CI, 2.90-4.80 years) if resected. CONCLUSION: A significant proportion of patients are not referred to a HBS because of advanced chronological age. Resection of hepatic metastases was associated with improved overall survival irrespective of initial tumor burden.
Authors: S Yousuf Zafar; Jennifer L Malin; Steven C Grambow; David H Abbott; Jane T Kolimaga; Leah L Zullig; Jane C Weeks; John Z Ayanian; Katherine L Kahn; Patricia A Ganz; Paul J Catalano; Dee W West; Dawn Provenzale Journal: Cancer Date: 2012-09-12 Impact factor: 6.860
Authors: Robert W Krell; Bradley N Reames; Samantha Hendren; Timothy L Frankel; Timothy M Pawlik; Mathew Chung; David Kwon; Sandra L Wong Journal: Ann Surg Oncol Date: 2015-01-13 Impact factor: 5.344
Authors: Kathleen De Greef; Christian Rolfo; Antonio Russo; Thiery Chapelle; Giuseppe Bronte; Francesco Passiglia; Andreia Coelho; Konstantinos Papadimitriou; Marc Peeters Journal: World J Gastroenterol Date: 2016-08-28 Impact factor: 5.742
Authors: Gabriela M Vargas; Abhishek D Parmar; Kristin M Sheffield; Nina P Tamirisa; Kimberly M Brown; Taylor S Riall Journal: J Surg Res Date: 2014-06-04 Impact factor: 2.192
Authors: Julie N Leal; Alexsander K Bressan; Neeta Vachharajani; Mithat Gonen; T Peter Kingham; Michael I D'Angelica; Peter J Allen; Ronald P DeMatteo; Majella B M Doyle; Oliver F Bathe; Paul D Greig; Alice Wei; William C Chapman; Elijah Dixon; William R Jarnagin Journal: J Am Coll Surg Date: 2016-01-30 Impact factor: 6.113
Authors: K Homayounfar; A Bleckmann; L C Conradi; T Sprenger; T Beissbarth; T Lorf; M Niessner; C O Sahlmann; J Meller; H Becker; T Liersch; B M Ghadimi Journal: Int J Colorectal Dis Date: 2012-03-21 Impact factor: 2.571