J 't Lam-Boer1, C Al Ali2, R H A Verhoeven3, R M H Roumen4, V E P P Lemmens5, A M Rijken6, J H W De Wilt7. 1. Department of Surgery, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: jorine.tlam-boer@radboudumc.nl. 2. Department of Surgery, Amphia Hospital, PO Box 90157, 4800 RL Breda, The Netherlands. Electronic address: calali@amphia.nl. 3. Netherlands Comprehensive Cancer Organisation, PO Box 90157, 4800 RL Breda, The Netherlands. Electronic address: r.verhoeven@ikz.nl. 4. Department of Surgery, Maxima Medical Centre, Postbus 7777, 5500 MB Veldhoven, The Netherlands. Electronic address: r.roumen@mmc.nl. 5. Netherlands Comprehensive Cancer Organisation, PO Box 90157, 4800 RL Breda, The Netherlands. Electronic address: v.lemmens@iknl.nl. 6. Department of Surgery, Amphia Hospital, PO Box 90157, 4800 RL Breda, The Netherlands. Electronic address: arijken@amphia.nl. 7. Department of Surgery, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: hans.dewilt@radboudumc.nl.
Abstract
BACKGROUND: Surgical resection of both the primary tumor and all metastases is considered the only chance of cure for patients with stage IV colorectal cancer. The aim of this study was to investigate change over time in the utilization of liver resections, as well as possible institutional variations. PATIENTS AND METHODS: All patients diagnosed with stage IV colorectal cancer with metastases confined to the liver (n = 1617) between 2004 and 2012 were selected from the population-based Eindhoven Cancer Registry. The proportion of patients undergoing liver resection was investigated. Institutional variation in the period 2010-2012 was analyzed using logistic regression. Kaplan-Meier and Cox regression analyses were used to analyze overall survival. RESULTS: The proportion of patients undergoing liver metastasectomy increased over time from 8% in 2004 to approximately 24% in 2012. There was a wide inter-hospital variation in the proportion of patients that underwent a liver resection (range: 14-34%) in the period 2010-2012. Liver resection was more often performed in younger patients and in rectal cancer patients. Median overall survival in patients undergoing liver resection was 55 months. Adjusted for potential confounders, resection of liver metastases was strongly associated with improved overall survival (HR 0.32, 95%CI 0.25-0.40). DISCUSSION: This study shows that despite the excellent long-term prognosis for patients with stage IV colorectal cancer after liver resection, there is still a large institutional variation in the utilization of this potentially curative therapy.
BACKGROUND: Surgical resection of both the primary tumor and all metastases is considered the only chance of cure for patients with stage IV colorectal cancer. The aim of this study was to investigate change over time in the utilization of liver resections, as well as possible institutional variations. PATIENTS AND METHODS: All patients diagnosed with stage IV colorectal cancer with metastases confined to the liver (n = 1617) between 2004 and 2012 were selected from the population-based Eindhoven Cancer Registry. The proportion of patients undergoing liver resection was investigated. Institutional variation in the period 2010-2012 was analyzed using logistic regression. Kaplan-Meier and Cox regression analyses were used to analyze overall survival. RESULTS: The proportion of patients undergoing liver metastasectomy increased over time from 8% in 2004 to approximately 24% in 2012. There was a wide inter-hospital variation in the proportion of patients that underwent a liver resection (range: 14-34%) in the period 2010-2012. Liver resection was more often performed in younger patients and in rectal cancerpatients. Median overall survival in patients undergoing liver resection was 55 months. Adjusted for potential confounders, resection of liver metastases was strongly associated with improved overall survival (HR 0.32, 95%CI 0.25-0.40). DISCUSSION: This study shows that despite the excellent long-term prognosis for patients with stage IV colorectal cancer after liver resection, there is still a large institutional variation in the utilization of this potentially curative therapy.
Authors: Mustafa Raoof; Zeljka Jutric; Sidra Haye; Philip H G Ituarte; Beiqun Zhao; Gagandeep Singh; Laleh Melstrom; Susanne G Warner; Bryan Clary; Yuman Fong Journal: Cancer Med Date: 2020-07-20 Impact factor: 4.452
Authors: Hayley M Fenton; John C Taylor; J Peter A Lodge; Giles J Toogood; Paul J Finan; Alastair L Young; Eva J A Morris Journal: Ann Surg Date: 2019-11 Impact factor: 12.969