Presenter: Annabelle Jones MD | Brigham and Women's Hospital Background: In select patients with colorectal cancer liver metastases (CRLM), liver metastasectomy with curative-intent has been found to be associated with a 5-year overall survival that is greater than 50%. Despite recent advancements, it is estimated that only half of potentially resectable patients with CRLM are undergoing liver metastasectomy. Previous studies have demonstrated that non-White patients were significantly less likely to undergo liver metastasectomy as compared to White patients. Additionally, hospital variation in access to liver metastasectomy is associated with hospital volume of surgery and medical care for the primary colorectal site. The aim of this study is to evaluate differences in access to metastasectomy for CRLM according to hospital-year volume of liver surgery (HVLS). We hypothesized that access to metastasectomy would be associated with HVLS, and that racial differences in access to metastasectomy would be lower in hospitals with the highest HVLS. Methods: The National Cancer Database (NCDB) Colon, Rectosigmoid Junction and Rectum data (2011-2017) were used to identify patients with a confirmed histology of colorectal adenocarcinoma who underwent primary site surgical resection and had confirmed liver metastases without evidence of extra-hepatic disease. Using the 2011-2017 Liver NCDB, hospitals were stratified into quartiles according to HVLS that included formal and extended hepatectomy and liver transplants. A Poisson regression model adjusted for age, gender, Charlson-Deyo score, insurance type, facility type, facility income quartiles, treatment at multiple facilities, and margin, nodal, and systemic therapy status for the primary colorectal cancer was used to evaluate the interaction between race and HVLS hospital quartiles (lowest and highest) and access to liver metastasectomy. Results: We identified 27,342 patients (median age 60, IQR 51-70, 55.6% male, 82.9% White, 17.2% non-White) with CRLM. The majority of patients did not undergo a liver metastasectomy (n = 20,714, 76%). Of the 6,628 patients treated with a liver metastasectomy, 45.4% (n = 3,009) underwent the liver metastasectomy at a hospital that did not perform any major liver surgery. Overall, non-White patients were less likely to undergo a liver metastasectomy compared to White patients after adjusting for potential confounders (RR 0.88, 95% CI 0.82-0.95, p = 0.001). Additional patient factors that were significantly associated with a lower likelihood of undergoing a liver metastasectomy included Medicaid insurance, being uninsured, and a positive margin status of the primary colorectal cancer. Among patients treated at the highest quartile HVLS hospitals, non-White patients were significantly less likely to undergo a liver metastasectomy for CRLM compared to White patients (RR 0.84, 95% CI 0.73-0.97, p = 0.017, Table). White and non-White patients treated at the lowest quartile HVLS hospitals had the lowest likelihood of undergoing a liver metastasectomy (Table). Conclusion: Undergoing a liver metastasectomy for CRLM was associated with where patients received their cancer care. Although patients who received their care at hospitals with the highest HVLS had a greater likelihood of undergoing a liver metastasectomy, this did not translate into equal access between White and non-White patients. Racial disparities persist in access to liver metastasectomy for CRLM, and future research is needed to develop innovative strategies that address this racial disparity in accessing liver metastasectomy.