A E Vallance1, J van der Meulen1,2, A Kuryba1, S C Charman1,2, I D Botterill3, K R Prasad3, J Hill4, D G Jayne3, K Walker1,2. 1. Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK. 2. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. 3. Leeds Teaching Hospitals NHS Trust, Leeds, UK. 4. Department of General Surgery, Manchester Royal Infirmary, Manchester, UK.
Abstract
AIM: There is uncertainty regarding the optimal sequence of surgery for patients with colorectal cancer (CRC) and synchronous liver metastases. This study was designed to describe temporal trends and inter-hospital variation in surgical strategy, and to compare long-term survival in a propensity score-matched analysis. METHOD: The National Bowel Cancer Audit dataset was used to identify patients diagnosed with primary CRC between 1 January 2010 and 31 December 2015 who underwent CRC resection in the English National Health Service. Hospital Episode Statistics data were used to identify those with synchronous liver-limited metastases who underwent liver resection. Survival outcomes of propensity score-matched groups were compared. RESULTS: Of 1830 patients, 270 (14.8%) underwent a liver-first approach, 259 (14.2%) a simultaneous approach and 1301 (71.1%) a bowel-first approach. The proportion of patients undergoing either a liver-first or simultaneous approach increased over the study period from 26.8% in 2010 to 35.6% in 2015 (P < 0.001). There was wide variation in surgical approach according to hospital trust of diagnosis. There was no evidence of a difference in 4-year survival between the propensity score-matched cohorts according to surgical strategy: bowel first vs simultaneous [hazard ratio (HR) 0.92 (95% CI: 0.80-1.06)] or bowel first vs liver first [HR 0.99 (95% CI: 0.82-1.19)]. CONCLUSION: There is evidence of wide variation in surgical strategy in dealing with CRC and synchronous liver metastases. In selected patients, the simultaneous and liver-first strategies have comparable long-term survival to the bowel-first approach. Colorectal Disease
AIM: There is uncertainty regarding the optimal sequence of surgery for patients with colorectal cancer (CRC) and synchronous liver metastases. This study was designed to describe temporal trends and inter-hospital variation in surgical strategy, and to compare long-term survival in a propensity score-matched analysis. METHOD: The National Bowel Cancer Audit dataset was used to identify patients diagnosed with primary CRC between 1 January 2010 and 31 December 2015 who underwent CRC resection in the English National Health Service. Hospital Episode Statistics data were used to identify those with synchronous liver-limited metastases who underwent liver resection. Survival outcomes of propensity score-matched groups were compared. RESULTS: Of 1830 patients, 270 (14.8%) underwent a liver-first approach, 259 (14.2%) a simultaneous approach and 1301 (71.1%) a bowel-first approach. The proportion of patients undergoing either a liver-first or simultaneous approach increased over the study period from 26.8% in 2010 to 35.6% in 2015 (P < 0.001). There was wide variation in surgical approach according to hospital trust of diagnosis. There was no evidence of a difference in 4-year survival between the propensity score-matched cohorts according to surgical strategy: bowel first vs simultaneous [hazard ratio (HR) 0.92 (95% CI: 0.80-1.06)] or bowel first vs liver first [HR 0.99 (95% CI: 0.82-1.19)]. CONCLUSION: There is evidence of wide variation in surgical strategy in dealing with CRC and synchronous liver metastases. In selected patients, the simultaneous and liver-first strategies have comparable long-term survival to the bowel-first approach. Colorectal Disease
Authors: Graziano Ceccarelli; Aldo Rocca; Michele De Rosa; Andrea Fontani; Fabio Ermili; Enrico Andolfi; Walter Bugiantella; Giovanni Battista Levi Sandri Journal: Updates Surg Date: 2021-04-08
Authors: Felice Giuliante; Luca Viganò; Agostino M De Rose; Darius F Mirza; Réal Lapointe; Gernot Kaiser; Eduardo Barroso; Alessandro Ferrero; Helena Isoniemi; Santiago Lopez-Ben; Irinel Popescu; Jean-Francois Ouellet; Catherine Hubert; Jean-Marc Regimbeau; Jen-Kou Lin; Oleg G Skipenko; Francesco Ardito; René Adam Journal: Ann Surg Oncol Date: 2021-07-01 Impact factor: 5.344