A Norén1, H G Eriksson2, L I Olsson3. 1. Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, 751 85 Uppsala, Sweden. 2. Centre for Clinical Research, Sörmland County Council, Uppsala University, 631 88 Eskilstuna, Sweden. 3. Centre for Clinical Research, Sörmland County Council, Uppsala University, 631 88 Eskilstuna, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska Universitetssjukhuset (L1:00) S-171 76 Stockholm, Sweden. Electronic address: louise.olsson@ki.se.
Abstract
BACKGROUND: Resection of colorectal liver metastases (CRLM) is associated with improved survival but we currently have limited population-based data on selection for surgery. METHODS: Patients in the Swedish Colorectal Cancer Register reported with liver metastases at diagnosis in 2007-2011 were identified. Clinical characteristics including American Society of Anesthesiologists classification, type of hospital and health care region were retrieved. Linkage to the National Patient Register and Statistics Sweden provided information on liver resection and socioeconomic variables. RESULTS: Synchronous CRLM was found in 4243/27,990 (15.2%) patients, of whom 1094 (25.8%) also had concurrent lung metastases. Of 3149 patients with liver-only metastases, 556 (17.8%) were subjected to liver resection. The resection rate varied by subsite; right-sided 11.7%, left-sided 19.7% and rectal cancer 22.7% (p = 0.001). It varied by type of hospital 14.1-23.6%, by region 11.5-22.7%, and was 19.8% in men and 14.9% in women (all p < 0.001). The adjusted odds were 0.74 (0.59-0.93) for females, 0.58 (0.46-0.74) for general district and 0.50 (0.37-0.68) for district hospital patients, and there were large regional differences. Patients >75 years were very unlikely to receive liver surgery 0.22 (0.15-0.32). In patients subjected to liver surgery, median survival was 57 months, 5-year survival rate was 45.4%, and those with left-sided colon cancer had the best outcome (48.8%; p = 0.02). Five-year hazard ratio for patients not subjected to liver surgery was 4.3 (3.7-5.0). CONCLUSION: Nationwide outcome after resection of synchronous CRLM was impressing but ambiguous selection mechanisms and inaccessibility need to be resolved. The implications of subsite deserve further attention.
BACKGROUND: Resection of colorectal liver metastases (CRLM) is associated with improved survival but we currently have limited population-based data on selection for surgery. METHODS:Patients in the Swedish Colorectal Cancer Register reported with liver metastases at diagnosis in 2007-2011 were identified. Clinical characteristics including American Society of Anesthesiologists classification, type of hospital and health care region were retrieved. Linkage to the National Patient Register and Statistics Sweden provided information on liver resection and socioeconomic variables. RESULTS: Synchronous CRLM was found in 4243/27,990 (15.2%) patients, of whom 1094 (25.8%) also had concurrent lung metastases. Of 3149 patients with liver-only metastases, 556 (17.8%) were subjected to liver resection. The resection rate varied by subsite; right-sided 11.7%, left-sided 19.7% and rectal cancer 22.7% (p = 0.001). It varied by type of hospital 14.1-23.6%, by region 11.5-22.7%, and was 19.8% in men and 14.9% in women (all p < 0.001). The adjusted odds were 0.74 (0.59-0.93) for females, 0.58 (0.46-0.74) for general district and 0.50 (0.37-0.68) for district hospital patients, and there were large regional differences. Patients >75 years were very unlikely to receive liver surgery 0.22 (0.15-0.32). In patients subjected to liver surgery, median survival was 57 months, 5-year survival rate was 45.4%, and those with left-sided colon cancer had the best outcome (48.8%; p = 0.02). Five-year hazard ratio for patients not subjected to liver surgery was 4.3 (3.7-5.0). CONCLUSION: Nationwide outcome after resection of synchronous CRLM was impressing but ambiguous selection mechanisms and inaccessibility need to be resolved. The implications of subsite deserve further attention.
Authors: Markus Albertsmeier; Andrea Engel; Markus O Guba; Sebastian Stintzing; Tobias S Schiergens; Gabriele Schubert-Fritschle; Dieter Hölzel; Jens Werner; Martin K Angele; Jutta Engel Journal: Langenbecks Arch Surg Date: 2017-08-12 Impact factor: 3.445
Authors: Nina J Wesdorp; Ruby Kemna; Jaap Stoker; Geert Kazemier; Karen Bolhuis; Jan H T M van Waesberghe; Irene M G C Nota; Femke Struik; Ikrame Oulad Abdennabi; Saffire S K S Phoa; Susan van Dieren; Martinus J van Amerongen; Thiery Chapelle; Cornelis H C Dejong; Marc R W Engelbrecht; Michael F Gerhards; Dirk Grünhagen; Thomas M van Gulik; John J Hermans; Koert P de Jong; Joost M Klaase; Mike S L Liem; Krijn P van Lienden; I Quintus Molenaar; Gijs A Patijn; Arjen M Rijken; Theo M Ruers; Cornelis Verhoef; Johannes H W de Wilt; Rutger-Jan Swijnenburg; Cornelis J A Punt; Joost Huiskens Journal: Radiol Imaging Cancer Date: 2022-05
Authors: Nelleke P M Brouwer; Dave E W van der Kruijssen; Niek Hugen; Ignace H J T de Hingh; Iris D Nagtegaal; Rob H A Verhoeven; Miriam Koopman; Johannes H W de Wilt Journal: Ann Surg Oncol Date: 2019-12-02 Impact factor: 5.344
Authors: Aditya Borakati; Farid Froghi; Alysha Shetye; Giuseppe K Fusai; Brian R Davidson; Reza Mirnezami Journal: World J Surg Date: 2022-03-24 Impact factor: 3.282
Authors: Valentinus T Valdimarsson; Ingvar Syk; Gert Lindell; Per Sandström; Bengt Isaksson; Magnus Rizell; Agneta Norén; Bjarne Ardnor; Christian Sturesson Journal: World J Surg Date: 2020-07 Impact factor: 3.352