Abstract
BackgroundCombining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation. MethodsIn this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery. ResultsOf 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy. ConclusionSignificant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy.
Highlights
Colorectal cancer (CRC) is the third most common type of cancer worldwide and colorectal liver metastases (CRLM) have been described to occur in up to 50% of patients with CRC.[1]
Patients who underwent combined resection and ablation were younger, had lower Charlson Comorbidity Index (CCI), had a history of liver resection less often, and received preoperative chemotherapy less often compared to patients who underwent resection only (Table 1)
Case-mix variables associated with liver resection and thermal ablation In multivariable multilevel logistic regression analysis case-mix variables that were positively associated with combined resection and ablation included preoperative chemotherapy, higher number of CRLM (4 or more CRLM, adjusted odds ratios (aOR) 3.56, Confidence Intervals (CI) 2.58–3.87, p < 0.001), and bilobar disease (Table 2)
Summary
Colorectal cancer (CRC) is the third most common type of cancer worldwide and colorectal liver metastases (CRLM) have been described to occur in up to 50% of patients with CRC.[1]. Combining liver resection and thermal ablation in one surgical session can extend curative options in patients with CRLM who are not eligible for conventional liver resection due to multiple CRLM, location of CRLM, bilobar disease or due to severe comorbidities.[8,9] Guidelines in the Netherlands provide insufficient guidance to support the combination of liver resection and thermal ablation in different patients and so the use of these treatment regimens may vary.[10] The present study is the first population-based nationwide study worldwide on hospital variation in the use of combined resection and ablation and on corresponding short-term postoperative outcomes. Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy
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