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Survival after hepatic resection of colorectal cancer metastases†‡

A national experience

  1. Douglas J. Robertson MD, MPH1,2,§,*,
  2. Therese A. Stukel PhD3,4,
  3. Daniel J. Gottlieb MS3,
  4. Jason M. Sutherland PhD3,
  5. Elliott S. Fisher MD, MPH3

Article first published online: 6 JAN 2009

DOI: 10.1002/cncr.24081

Issue

Cancer

Cancer

Volume 115, Issue 4, pages 752–759, 15 February 2009

Additional Information

How to Cite

Robertson, D. J., Stukel, T. A., Gottlieb, D. J., Sutherland, J. M. and Fisher, E. S. (2009), Survival after hepatic resection of colorectal cancer metastases. Cancer, 115: 752–759. doi: 10.1002/cncr.24081

Author Information

  1. 1

    Veterans Affairs Outcomes Group, Veterans Affairs Medical Center, White River Junction, Vermont

  2. 2

    Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire

  3. 3

    The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire

  4. 4

    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

  1. §

    Fax: (802) 296-6325

*Veterans Affairs Outcomes Research Group (111B), Veterans Affairs Medical Center, 215 N Main Street, White River Junction, VT 05009

  1. †

    The contents of this article do not represent the views of the Department of Veterans Affairs or the United States Government.

  2. ‡

    See editorial on pages 702-3, this issue.

Publication History

  1. Issue published online: 2 FEB 2009
  2. Article first published online: 6 JAN 2009
  3. Manuscript Accepted: 1 JUL 2008
  4. Manuscript Revised: 6 JUN 2008
  5. Manuscript Received: 14 APR 2008

Funded by

  • Robert Wood Johnson Foundation
  • National Institutes of Health. Grant Number: CA52192
  • Department of Veterans Affairs Health Services Research and Development Career Development Award

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Keywords:

  • comorbid disease;
  • early mortality;
  • long-term survival;
  • Medicare Denominator File;
  • surgical expertise;
  • synchronous resection

The authors of this report analyzed Medicare data from patients who had a history of colorectal cancer and resection who also underwent hepatic resection of liver metastases. The rates of early mortality (8.2% at 90 days) and long-term survival (25.5% at 5 years) were not as good as the rates reported in single-center surgical case series.

Abstract

BACKGROUND:

Most estimates of short- and long-term survival after hepatic resection of colorectal cancer metastases are derived from surgical case series. For the current report, the authors used Medicare data to investigate operative mortality and long-term survival in a national sample and examined the factors associated with survival.

METHODS:

Data were analyzed from Medicare enrollees (age ≥65 years) who were admitted to hospital between January 1, 2000 and December 31, 2004 with a primary diagnosis of colorectal cancer with resection. The sample was restricted to patients who subsequently underwent hepatic resection for liver metastases. The Medicare Denominator File was used to determine operative mortality and long-term survival and the factors that were associated with those outcomes.

RESULTS:

Of the 306,061 Medicare beneficiaries who were diagnosed with colorectal cancer, 3957 patients were identified who underwent hepatic resection for liver metastases. The crude 30-day and 90-day mortality rates were 4% and 8.2%, respectively, and the 5-year survival rate was 25.5%. Advancing age (hazards ratio [HR], 1.83; 95% confidence interval [95% CI], 1.32-2.53 for age ≥80 years vs ages 65-69 years), comorbid disease (HR, 1.40; 95% CI, 1.06-1.85 for Charlson ≥5 vs Charlson 0), and synchronous colon/hepatic resection (HR, 2.46; 95% CI, 1.89-3.20 for synchronous vs metachronous resection) were associated with worse 90-day mortality. Similarly, long-term mortality was associated with age (HR, 1.36; 95% CI, 1.18-1.56), comorbid disease (HR, 1.51; 95% CI, 1.36-1.69), and synchronous colon/hepatic resection (HR, 1.37; 95% CI, 1.24-1.51 for synchronous vs metachronous resection).

CONCLUSIONS:

In this national study, short- and long-term survival was worse than that reported in surgical case series. Subgroups at high risk for worse outcomes include the extreme elderly and those undergoing synchronous colon and hepatic resection. Cancer 2009. © 2009 American Cancer Society.

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