A national perspective on the surgical management and outcomes of colorectal cancer liver metastases
Eva Morris1, David Forman1, James Thomas1, Phil Quirke1, Brian Cottier2, Graeme Poston3
1University of Leeds, Leeds, UK, 2National Cancer Services Analysis Team, Wirral, UK, 3University Hospital Aintree, Liverpool, UK
Background
Hepatic resection is increasingly employed for the treatment of colorectal metastases confined to the liver. However the evidence for the effectiveness of this approach is based on single centre case series of relatively small patient numbers. Via the linkage of routine health datasets this population-based study allows us, for the first time, to examine the frequency of hepatic resections for colorectal metastases across England and investigate their outcome.
Method
All individuals who underwent surgery for colorectal cancer between 1998 and 2001 within the English NHS were identified via the national linked cancer registry HES dataset. All episodes of care for these patients in the three years following their initial colorectal surgery were examined to determine the frequency of subsequent liver resection. Variations in the use of liver resection and survival were then assessed.
Results
67,879 individuals were identified as undergoing surgery for colorectal cancer over the study period. 1,501 (2.1%) subsequently underwent liver resection within three years of their colorectal operation. The rate of hepatectomy increased over time from 1.6% of patients in 1998 to 2.8% in 2001. There was significant variation in the use of liver resections across cancer networks with rates varying between 0.8% and 3.9%. 55 patients died within 30 days of liver resection (post-operative mortality rate: 3.7%). Crude 5-year survival of patients following liver resection was 32.8% (95%CI 30.2-35.5%) from time of hepatectomy and 41.6% (95%CI 39.0-44.1%) from time of colectomy. This rate was comparable to the five-year survival of all Stage 3 patients (38.6% (95%CI 37.9%-39.2%)).
Conclusion
The rate of resection of liver metastases increased by 60% over the study period but significant variation in the frequency of its use existed between cancer networks. 5-year survival of patients who underwent liver resection was comparable to patients with Stage 3 colorectal cancer.
