Surgical management and outcomes of colorectal cancer liver metastases

Background: This population-based study investigated the frequency of hepatic resections for colorectal cancer metastases across England and their outcome. Methods: Individuals who underwent surgery for colorectal cancer between January 1998 and June 2004 within the English National Health Service were identified via the National Cancer Data Repository. All episodes of care in the 3 years after the initial operation were examined to determine the frequency of liver resection. Variations in the use of liver resection and survival were assessed. Results: Some 114 155 individuals underwent surgery for colorectal cancer over the study period, of whom 3116 (2.7 per cent) subsequently had one or more hepatic resections. The hepatectomy rate increased from 1.7 per cent in 1998 to 3.8 per cent in 2004. There was significant variation in the rate of liver resection across cancer networks (range 1.1-4.3 per cent) and hospitals (range 0.7-6.8 per cent). The crude 5-year survival rate after liver resection was 44.2 (95 per cent confidence interval (c.i.) 42.4 to 46.1) per cent from the time of hepatectomy and 45.9 (95 per cent c.i. 44.1 to 47.7) per cent from the time of colectomy. This was comparable to the 5-year survival rate of patients with stage III disease (42.2 (95 per cent c.i. 41.7 to 42.7) per cent). Conclusion: The rate of resection of liver metastases increased over the study period but varied significantly across the country. Patients who underwent liver resection had 5-year survival comparable to that of patients with stage III colorectal cancer.