Myrtle F Krul1, Arthur K E Elfrink2, Carlijn I Buis3, Rutger-Jan Swijnenburg4, Wouter W Te Riele5, Cornelis Verhoef6, Paul D Gobardhan7, Marcel den Dulk8, Mike S L Liem9, Pieter J Tanis4, J S D Mieog10, Peter B van den Boezem11, Wouter K G Leclercq12, Vincent B Nieuwenhuijs13, Michael F Gerhards14, Joost M Klaase3, Dirk J Grünhagen6, Niels F M Kok15, Koert F D Kuhlmann15. 1. Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands. Electronic address: m.krul@nki.nl. 2. Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands. 3. Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands. 4. Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 5. Department of Surgery, Regional Academic Cancer Centre Utrecht, UMC Utrecht, Utrecht and St. Antonius Hospital, Nieuwegein, the Netherlands. 6. Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands. 7. Department of Surgery, Amphia Hospital, Breda, the Netherlands. 8. Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands. 9. Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands. 10. Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands. 11. Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands. 12. Department of Surgery, Maxima Medical Centre, Eindhoven, Veldhoven, the Netherlands. 13. Department of Surgery, Isala, Zwolle, the Netherlands. 14. Department of Surgery, OLVG, Amsterdam, the Netherlands. 15. Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Abstract
BACKGROUND: The optimal treatment sequence for patients with synchronous colorectal liver metastases (CRLM) remains uncertain. This study aimed to assess factors associated with the use of simultaneous resections and impact on hospital variation. METHOD: This population-based study included all patients who underwent liver surgery for synchronous colorectal liver metastases between 2014 and 2019 in the Netherlands. Factors associated with simultaneous resection were identified. Short-term surgical outcomes of simultaneous resections and factors associated with 30-day major morbidity were evaluated. RESULTS: Of 2146 patients included, 589 (27%) underwent simultaneous resection in 28 hospitals. Simultaneous resection was associated with age, sex, BMI, number, size and bilobar distribution of CRLM, and administration of preoperative chemotherapy. More minimally invasive and minor resections were performed in the simultaneous group. Hospital variation was present (range 2.4%-83.3%) with several hospitals performing simultaneous procedures more and less frequently than expected. Simultaneous resection resulted in 13% 30-day major morbidity, and 1% mortality. ASA classification ≥3 was independently associated with higher 30-day major morbidity after simultaneous resection (aOR 1.97, CI 1.10-3.42, p = 0.018). CONCLUSION: Distinctive patient and tumour characteristics influence the choice for simultaneous resection. Remarkable hospital variation is present in the Netherlands.
BACKGROUND: The optimal treatment sequence for patients with synchronous colorectal liver metastases (CRLM) remains uncertain. This study aimed to assess factors associated with the use of simultaneous resections and impact on hospital variation. METHOD: This population-based study included all patients who underwent liver surgery for synchronous colorectal liver metastases between 2014 and 2019 in the Netherlands. Factors associated with simultaneous resection were identified. Short-term surgical outcomes of simultaneous resections and factors associated with 30-day major morbidity were evaluated. RESULTS: Of 2146 patients included, 589 (27%) underwent simultaneous resection in 28 hospitals. Simultaneous resection was associated with age, sex, BMI, number, size and bilobar distribution of CRLM, and administration of preoperative chemotherapy. More minimally invasive and minor resections were performed in the simultaneous group. Hospital variation was present (range 2.4%-83.3%) with several hospitals performing simultaneous procedures more and less frequently than expected. Simultaneous resection resulted in 13% 30-day major morbidity, and 1% mortality. ASA classification ≥3 was independently associated with higher 30-day major morbidity after simultaneous resection (aOR 1.97, CI 1.10-3.42, p = 0.018). CONCLUSION: Distinctive patient and tumour characteristics influence the choice for simultaneous resection. Remarkable hospital variation is present in the Netherlands.