Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases: a nationwide cohort study

Michelle R de Graaff; Joost M Klaase; Marcel den Dulk; Wouter W Te Riele; Jeroen Hagendoorn; N Tjarda van Heek; M Vermaas; Eric J Th Belt; Koop Bosscha; Gerrit D Slooter; Wouter K G Leclercq; Mike S L Liem; J Sven D Mieog; Rutger-Jan Swijnenburg; Ronald M van Dam; Cees Verhoef; Koert Kuhlmann; Peter van Duijvendijk; Michael F Gerhards; Paul Gobardhan; Peter van den Boezem; Eric R Manusama; Dirk J Grünhagen; Niels F M Kok

doi:10.1016/j.hpb.2024.02.014

Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases: a nationwide cohort study

Michelle R de Graaff, Joost M Klaase, Marcel den Dulk, Wouter W Te Riele, Jeroen Hagendoorn, N Tjarda van Heek, M Vermaas, Eric J Th Belt, Koop Bosscha, Gerrit D Slooter, Wouter K G Leclercq, Mike S L Liem, J Sven D Mieog, Rutger-Jan Swijnenburg, Ronald M van Dam, Cees Verhoef, Koert Kuhlmann, Peter van Duijvendijk, Michael F Gerhards, Paul GobardhanPeter van den Boezem, Eric R Manusama, Dirk J Grünhagen, Niels F M Kok^*,

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: 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).

METHODS: 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.

RESULTS: 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%).

CONCLUSION: 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.

Original language	English
Pages (from-to)	789-799
Number of pages	11
Journal	International Hepato-Pancreato Biliary Association.
Volume	26
Issue number	6
DOIs	https://doi.org/10.1016/j.hpb.2024.02.014
Publication status	Published - Jun 2024

Keywords

Aged
Colorectal Neoplasms/pathology
Databases, Factual
Female
Hepatectomy/mortality
Hospitals/statistics & numerical data
Humans
Liver Neoplasms/secondary
Male
Middle Aged
Neoplasm Recurrence, Local
Netherlands
Reoperation
Retrospective Studies
Treatment Outcome

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de Graaff, M. R., Klaase, J. M., den Dulk, M., Te Riele, W. W., Hagendoorn, J., van Heek, N. T., Vermaas, M., Belt, E. J. T., Bosscha, K., Slooter, G. D., Leclercq, W. K. G., Liem, M. S. L., Mieog, J. S. D., Swijnenburg, R.-J., van Dam, R. M., Verhoef, C., Kuhlmann, K., van Duijvendijk, P., Gerhards, M. F. (2024). Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases: a nationwide cohort study. International Hepato-Pancreato Biliary Association., 26(6), 789-799. https://doi.org/10.1016/j.hpb.2024.02.014

@article{dd8e5da709894853b1f59fdc7677a830,

title = "Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases: a nationwide cohort study",

abstract = "BACKGROUND: 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).METHODS: 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.RESULTS: 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%).CONCLUSION: 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.",

keywords = "Aged, Colorectal Neoplasms/pathology, Databases, Factual, Female, Hepatectomy/mortality, Hospitals/statistics & numerical data, Humans, Liver Neoplasms/secondary, Male, Middle Aged, Neoplasm Recurrence, Local, Netherlands, Reoperation, Retrospective Studies, Treatment Outcome",

author = "{de Graaff}, {Michelle R} and Klaase, {Joost M} and {den Dulk}, Marcel and {Te Riele}, {Wouter W} and Jeroen Hagendoorn and {van Heek}, {N Tjarda} and M Vermaas and Belt, {Eric J Th} and Koop Bosscha and Slooter, {Gerrit D} and Leclercq, {Wouter K G} and Liem, {Mike S L} and Mieog, {J Sven D} and Rutger-Jan Swijnenburg and {van Dam}, {Ronald M} and Cees Verhoef and Koert Kuhlmann and {van Duijvendijk}, Peter and Gerhards, {Michael F} and Paul Gobardhan and {van den Boezem}, Peter and Manusama, {Eric R} and Gr{\"u}nhagen, {Dirk J} and Kok, {Niels F M}",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s)",

year = "2024",

month = jun,

doi = "10.1016/j.hpb.2024.02.014",

language = "English",

volume = "26",

pages = "789--799",

number = "6",

}

de Graaff, MR, Klaase, JM, den Dulk, M, Te Riele, WW, Hagendoorn, J, van Heek, NT, Vermaas, M, Belt, EJT, Bosscha, K, Slooter, GD, Leclercq, WKG, Liem, MSL, Mieog, JSD, Swijnenburg, R-J, van Dam, RM, Verhoef, C, Kuhlmann, K, van Duijvendijk, P, Gerhards, MF, Gobardhan, P, van den Boezem, P, Manusama, ER, Grünhagen, DJ, Kok, NFM 2024, 'Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases: a nationwide cohort study', International Hepato-Pancreato Biliary Association., vol. 26, no. 6, pp. 789-799. https://doi.org/10.1016/j.hpb.2024.02.014

TY - JOUR

T1 - Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases

T2 - a nationwide cohort study

AU - de Graaff, Michelle R

AU - Klaase, Joost M

AU - den Dulk, Marcel

AU - Te Riele, Wouter W

AU - Hagendoorn, Jeroen

AU - van Heek, N Tjarda

AU - Vermaas, M

AU - Belt, Eric J Th

AU - Bosscha, Koop

AU - Slooter, Gerrit D

AU - Leclercq, Wouter K G

AU - Liem, Mike S L

AU - Mieog, J Sven D

AU - Swijnenburg, Rutger-Jan

AU - van Dam, Ronald M

AU - Verhoef, Cees

AU - Kuhlmann, Koert

AU - van Duijvendijk, Peter

AU - Gerhards, Michael F

AU - Gobardhan, Paul

AU - van den Boezem, Peter

AU - Manusama, Eric R

AU - Grünhagen, Dirk J

AU - Kok, Niels F M

PY - 2024/6

Y1 - 2024/6

N2 - BACKGROUND: 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).METHODS: 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.RESULTS: 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%).CONCLUSION: 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.

AB - BACKGROUND: 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).METHODS: 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.RESULTS: 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%).CONCLUSION: 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.

KW - Aged

KW - Colorectal Neoplasms/pathology

KW - Databases, Factual

KW - Female

KW - Hepatectomy/mortality

KW - Hospitals/statistics & numerical data

KW - Humans

KW - Liver Neoplasms/secondary

KW - Male

KW - Middle Aged

KW - Neoplasm Recurrence, Local

KW - Netherlands

KW - Reoperation

KW - Retrospective Studies

KW - Treatment Outcome

UR - http://www.scopus.com/inward/record.url?scp=85187371433&partnerID=8YFLogxK

U2 - 10.1016/j.hpb.2024.02.014

DO - 10.1016/j.hpb.2024.02.014

M3 - Article

C2 - 38461070

SN - 1365-182X

VL - 26

SP - 789

EP - 799

JO - International Hepato-Pancreato Biliary Association.

JF - International Hepato-Pancreato Biliary Association.

IS - 6

ER -

Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases: a nationwide cohort study

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