Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases: a nationwide cohort study
Approximately 70% of patients with colorectal liver metastases (CRLM) experiences intrahepatic recurrence after initial liver resection. This study assessed outcomes and hospital variation in repeat liver resections (R-LR). This population-based study included all patients who underwent liver resect...
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| creator | de Graaff, Michelle R. Klaase, Joost M. den Dulk, Marcel te Riele, Wouter W. Hagendoorn, Jeroen van Heek, N. Tjarda Vermaas, M. Belt, Eric J. Th Bosscha, Koop Slooter, Gerrit D. Leclercq, Wouter K.G. Liem, Mike S.L. Mieog, J. Sven D. Swijnenburg, Rutger-Jan van Dam, Ronald M. Verhoef, Cees Kuhlmann, Koert van Duijvendijk, Peter Gerhards, Michael F. Gobardhan, Paul van den Boezem, Peter Manusama, Eric R. Grünhagen, Dirk J. Kok, Niels F.M. Torrenga, Hans |
| description | Approximately 70% of patients with colorectal liver metastases (CRLM) experiences intrahepatic recurrence after initial liver resection. This study assessed outcomes and hospital variation in repeat liver resections (R-LR).
This population-based study included all patients who underwent liver resection for CRLM between 2014 and 2022 in the Netherlands. Overall survival (OS) was collected for patients operated on between 2014 and 2018 by linkage to the insurance database.
Data of 7479 liver resections (1391 (18.6%) repeat and 6088 (81.4%) primary) were analysed. Major morbidity and mortality were not different. Factors associated with major morbidity included ASA 3+, major liver resection, extrahepatic disease, and open surgery. Five-year OS after repeat versus primary liver resection was 42.3% versus 44.8%, P = 0.37. Factors associated with worse OS included largest CRLM >5 cm (aHR 1.58, 95% CI: 1.07–2.34, P = 0.023), >3 CRLM (aHR 1.33, 95% CI: 1.00–1.75, P = 0.046), extrahepatic disease (aHR 1.60, 95% CI: 1.25–2.04, P = 0.001), positive tumour margins (aHR 1.42, 95% CI: 1.09–1.85, P = 0.009). Significant hospital variation in performance of R-LR was observed, median 18.9% (8.2% to 33.3%).
Significant hospital variation was observed in performance of R-LR in the Netherlands reflecting different treatment decisions upon recurrence. On a population-based level R-LR leads to satisfactory survival. |
| doi_str_mv | 10.1016/j.hpb.2024.02.014 |
| format | Article |
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This population-based study included all patients who underwent liver resection for CRLM between 2014 and 2022 in the Netherlands. Overall survival (OS) was collected for patients operated on between 2014 and 2018 by linkage to the insurance database.
Data of 7479 liver resections (1391 (18.6%) repeat and 6088 (81.4%) primary) were analysed. Major morbidity and mortality were not different. Factors associated with major morbidity included ASA 3+, major liver resection, extrahepatic disease, and open surgery. Five-year OS after repeat versus primary liver resection was 42.3% versus 44.8%, P = 0.37. Factors associated with worse OS included largest CRLM >5 cm (aHR 1.58, 95% CI: 1.07–2.34, P = 0.023), >3 CRLM (aHR 1.33, 95% CI: 1.00–1.75, P = 0.046), extrahepatic disease (aHR 1.60, 95% CI: 1.25–2.04, P = 0.001), positive tumour margins (aHR 1.42, 95% CI: 1.09–1.85, P = 0.009). Significant hospital variation in performance of R-LR was observed, median 18.9% (8.2% to 33.3%).
Significant hospital variation was observed in performance of R-LR in the Netherlands reflecting different treatment decisions upon recurrence. On a population-based level R-LR leads to satisfactory survival.</description><identifier>ISSN: 1365-182X</identifier><identifier>ISSN: 1477-2574</identifier><identifier>EISSN: 1477-2574</identifier><identifier>DOI: 10.1016/j.hpb.2024.02.014</identifier><identifier>PMID: 38461070</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Aged ; Colorectal Neoplasms - mortality ; Colorectal Neoplasms - pathology ; Colorectal Neoplasms - surgery ; Databases, Factual ; Female ; Hepatectomy - adverse effects ; Hepatectomy - mortality ; Hospitals - statistics & numerical data ; Humans ; Liver Neoplasms - mortality ; Liver Neoplasms - secondary ; Liver Neoplasms - surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Netherlands ; Reoperation ; Retrospective Studies ; Treatment Outcome</subject><ispartof>HPB (Oxford, England), 2024-06, Vol.26 (6), p.789-799</ispartof><rights>2024 The Author(s)</rights><rights>Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c348t-55761b155978e06e4c2ec45f39c8805dc95c8c768dab9314dd7b1965d629174a3</cites><orcidid>0000-0001-8415-5090 ; 0000-0002-5957-5824 ; 0000-0002-6161-161X ; 0000-0002-3980-4634 ; 0000-0002-0441-6180 ; 0000-0003-1159-1857 ; 0000-0002-7961-3314 ; 0000-0001-8293-6002</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38461070$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>de Graaff, Michelle R.</creatorcontrib><creatorcontrib>Klaase, Joost M.</creatorcontrib><creatorcontrib>den Dulk, Marcel</creatorcontrib><creatorcontrib>te Riele, Wouter W.</creatorcontrib><creatorcontrib>Hagendoorn, Jeroen</creatorcontrib><creatorcontrib>van Heek, N. Tjarda</creatorcontrib><creatorcontrib>Vermaas, M.</creatorcontrib><creatorcontrib>Belt, Eric J. Th</creatorcontrib><creatorcontrib>Bosscha, Koop</creatorcontrib><creatorcontrib>Slooter, Gerrit D.</creatorcontrib><creatorcontrib>Leclercq, Wouter K.G.</creatorcontrib><creatorcontrib>Liem, Mike S.L.</creatorcontrib><creatorcontrib>Mieog, J. Sven D.</creatorcontrib><creatorcontrib>Swijnenburg, Rutger-Jan</creatorcontrib><creatorcontrib>van Dam, Ronald M.</creatorcontrib><creatorcontrib>Verhoef, Cees</creatorcontrib><creatorcontrib>Kuhlmann, Koert</creatorcontrib><creatorcontrib>van Duijvendijk, Peter</creatorcontrib><creatorcontrib>Gerhards, Michael F.</creatorcontrib><creatorcontrib>Gobardhan, Paul</creatorcontrib><creatorcontrib>van den Boezem, Peter</creatorcontrib><creatorcontrib>Manusama, Eric R.</creatorcontrib><creatorcontrib>Grünhagen, Dirk J.</creatorcontrib><creatorcontrib>Kok, Niels F.M.</creatorcontrib><creatorcontrib>Torrenga, Hans</creatorcontrib><creatorcontrib>Dutch Hepato Biliary Audit Group, Collaborators</creatorcontrib><title>Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases: a nationwide cohort study</title><title>HPB (Oxford, England)</title><addtitle>HPB (Oxford)</addtitle><description>Approximately 70% of patients with colorectal liver metastases (CRLM) experiences intrahepatic recurrence after initial liver resection. This study assessed outcomes and hospital variation in repeat liver resections (R-LR).
This population-based study included all patients who underwent liver resection for CRLM between 2014 and 2022 in the Netherlands. Overall survival (OS) was collected for patients operated on between 2014 and 2018 by linkage to the insurance database.
Data of 7479 liver resections (1391 (18.6%) repeat and 6088 (81.4%) primary) were analysed. Major morbidity and mortality were not different. Factors associated with major morbidity included ASA 3+, major liver resection, extrahepatic disease, and open surgery. Five-year OS after repeat versus primary liver resection was 42.3% versus 44.8%, P = 0.37. Factors associated with worse OS included largest CRLM >5 cm (aHR 1.58, 95% CI: 1.07–2.34, P = 0.023), >3 CRLM (aHR 1.33, 95% CI: 1.00–1.75, P = 0.046), extrahepatic disease (aHR 1.60, 95% CI: 1.25–2.04, P = 0.001), positive tumour margins (aHR 1.42, 95% CI: 1.09–1.85, P = 0.009). Significant hospital variation in performance of R-LR was observed, median 18.9% (8.2% to 33.3%).
Significant hospital variation was observed in performance of R-LR in the Netherlands reflecting different treatment decisions upon recurrence. On a population-based level R-LR leads to satisfactory survival.</description><subject>Aged</subject><subject>Colorectal Neoplasms - mortality</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Colorectal Neoplasms - surgery</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Hepatectomy - adverse effects</subject><subject>Hepatectomy - mortality</subject><subject>Hospitals - statistics & numerical data</subject><subject>Humans</subject><subject>Liver Neoplasms - mortality</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local</subject><subject>Netherlands</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>1365-182X</issn><issn>1477-2574</issn><issn>1477-2574</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1q3DAUhUVpaH7aB8gmaNmNXUmWLDldlZA_CHSTQndClq4ZDbblSPKUeftqMmmWhQu6F75zQB9Cl5TUlND227beLH3NCOM1YTWh_AM6o1zKignJP5a9aUVFFft9is5T2hLCSqz7hE4bxVtKJDlD-4eQFp_NiHcmepN9mLGZHQ5rtmGChM2QIeIIC5iMN7AUxJYzgX1lhxCxDWOI5S4lo98VeoJsUhlI19jg-bX1j3dQyE2IGae8uv1ndDKYMcGXt_cC_bq7fb55qJ5-3j_e_HiqbMNVroSQLe2pEJ1UQFrgloHlYmg6qxQRznbCKitb5UzfNZQ7J3vatcK1rKOSm-YCfT32LjG8rJCynnyyMI5mhrAmzTpRlFGuREHpEbUxpBRh0Ev0k4l7TYk-GNdbXYzrg3FNmC7GS-bqrX7tJ3DviX-KC_D9CED55M5D1Ml6mC04f5CmXfD_qf8LtNCTNQ</recordid><startdate>202406</startdate><enddate>202406</enddate><creator>de Graaff, Michelle R.</creator><creator>Klaase, Joost M.</creator><creator>den Dulk, Marcel</creator><creator>te Riele, Wouter W.</creator><creator>Hagendoorn, Jeroen</creator><creator>van Heek, N. 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Tjarda ; Vermaas, M. ; Belt, Eric J. Th ; Bosscha, Koop ; Slooter, Gerrit D. ; Leclercq, Wouter K.G. ; Liem, Mike S.L. ; Mieog, J. 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Tjarda</au><au>Vermaas, M.</au><au>Belt, Eric J. Th</au><au>Bosscha, Koop</au><au>Slooter, Gerrit D.</au><au>Leclercq, Wouter K.G.</au><au>Liem, Mike S.L.</au><au>Mieog, J. Sven D.</au><au>Swijnenburg, Rutger-Jan</au><au>van Dam, Ronald M.</au><au>Verhoef, Cees</au><au>Kuhlmann, Koert</au><au>van Duijvendijk, Peter</au><au>Gerhards, Michael F.</au><au>Gobardhan, Paul</au><au>van den Boezem, Peter</au><au>Manusama, Eric R.</au><au>Grünhagen, Dirk J.</au><au>Kok, Niels F.M.</au><au>Torrenga, Hans</au><aucorp>Dutch Hepato Biliary Audit Group, Collaborators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases: a nationwide cohort study</atitle><jtitle>HPB (Oxford, England)</jtitle><addtitle>HPB (Oxford)</addtitle><date>2024-06</date><risdate>2024</risdate><volume>26</volume><issue>6</issue><spage>789</spage><epage>799</epage><pages>789-799</pages><issn>1365-182X</issn><issn>1477-2574</issn><eissn>1477-2574</eissn><abstract>Approximately 70% of patients with colorectal liver metastases (CRLM) experiences intrahepatic recurrence after initial liver resection. This study assessed outcomes and hospital variation in repeat liver resections (R-LR).
This population-based study included all patients who underwent liver resection for CRLM between 2014 and 2022 in the Netherlands. Overall survival (OS) was collected for patients operated on between 2014 and 2018 by linkage to the insurance database.
Data of 7479 liver resections (1391 (18.6%) repeat and 6088 (81.4%) primary) were analysed. Major morbidity and mortality were not different. Factors associated with major morbidity included ASA 3+, major liver resection, extrahepatic disease, and open surgery. Five-year OS after repeat versus primary liver resection was 42.3% versus 44.8%, P = 0.37. Factors associated with worse OS included largest CRLM >5 cm (aHR 1.58, 95% CI: 1.07–2.34, P = 0.023), >3 CRLM (aHR 1.33, 95% CI: 1.00–1.75, P = 0.046), extrahepatic disease (aHR 1.60, 95% CI: 1.25–2.04, P = 0.001), positive tumour margins (aHR 1.42, 95% CI: 1.09–1.85, P = 0.009). Significant hospital variation in performance of R-LR was observed, median 18.9% (8.2% to 33.3%).
Significant hospital variation was observed in performance of R-LR in the Netherlands reflecting different treatment decisions upon recurrence. On a population-based level R-LR leads to satisfactory survival.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>38461070</pmid><doi>10.1016/j.hpb.2024.02.014</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-8415-5090</orcidid><orcidid>https://orcid.org/0000-0002-5957-5824</orcidid><orcidid>https://orcid.org/0000-0002-6161-161X</orcidid><orcidid>https://orcid.org/0000-0002-3980-4634</orcidid><orcidid>https://orcid.org/0000-0002-0441-6180</orcidid><orcidid>https://orcid.org/0000-0003-1159-1857</orcidid><orcidid>https://orcid.org/0000-0002-7961-3314</orcidid><orcidid>https://orcid.org/0000-0001-8293-6002</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Colorectal Neoplasms - mortality Colorectal Neoplasms - pathology Colorectal Neoplasms - surgery Databases, Factual Female Hepatectomy - adverse effects Hepatectomy - mortality Hospitals - statistics & numerical data Humans Liver Neoplasms - mortality Liver Neoplasms - secondary Liver Neoplasms - surgery Male Middle Aged Neoplasm Recurrence, Local Netherlands Reoperation Retrospective Studies Treatment Outcome |
| title | Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases: a nationwide cohort study |
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