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Trends in the Multimodality Treatment of Resectable Colorectal Liver Metastases: an Underutilized Strategy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Objective

Advances in multimodality therapy have led to increased survival for patients with metastatic colorectal cancer, but the impact on patients undergoing resection for colorectal liver metastases is unclear. The purpose of this study was to evaluate patterns of treatment for resectable colorectal liver metastases in the USA over the last two decades.

Methods

Using the Surveillance, Epidemiology, and End Results-Medicare database, 1,926 patients who underwent hepatic resection for colorectal liver metastasis between 1991 and 2007 were included and divided into two cohorts: period 1 (1991–2000) and period 2 (2001–2007). Demographic data, treatment patterns, and outcomes of the two periods were compared by univariate methods. Multivariable regression models were constructed to predict the use of perioperative chemotherapy, postoperative complications, and 90-day mortality following liver resection.

Results

The overall use of perioperative chemotherapy was 33 % and did not differ between periods, but shifted from postoperative to preoperative over time. By multivariable analysis, older age, black race, stage III primary cancer, and metachronous disease were predictive of lesser likelihood of chemotherapy use. The use of preoperative chemotherapy was not associated with any increase in perioperative morbidity or mortality.

Conclusions

Despite increased survival and widespread recommendations for the use of multimodality therapy, the overall resection rate and use of perioperative chemotherapy for resectable colorectal liver metastases remain underutilized and have not increased over time. Efforts to investigate barriers to the widespread use of multimodality therapy for these patients are warranted.

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Acknowledgments

The project described was supported in part by CTSA award no. UL1TR000445 (VICTR 1259) from the National Center for Advancing Translational Sciences of the National Institutes of Health. The contents of this work are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

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Authors and Affiliations

  1. Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA

    Alexander A. Parikh

  2. Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA

    Shenghua Ni & David Penson

  3. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA

    Tatsuki Koyama

  4. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Timothy M. Pawlik

  5. Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA

    David Penson

  6. Division of Surgical Oncology, Vanderbilt University Medical Center, 597 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA

    Alexander A. Parikh

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  1. Alexander A. Parikh
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Correspondence to Alexander A. Parikh.

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Parikh, A.A., Ni, S., Koyama, T. et al. Trends in the Multimodality Treatment of Resectable Colorectal Liver Metastases: an Underutilized Strategy. J Gastrointest Surg 17, 1938–1946 (2013). https://doi.org/10.1007/s11605-013-2325-z

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  • DOI: https://doi.org/10.1007/s11605-013-2325-z

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