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Outcomes of Resected Colorectal Cancer Lung Metastases in Routine Clinical Practice: A Population-Based Study

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Previous reports on the outcome of surgery for colorectal cancer lung metastases (CRCLM) have come from high-volume centers. This report describes the outcomes achieved in the general population of Ontario.

Methods

All patients in Ontario who underwent resection of CRCLM between 1994 and 2009 were identified using the population-based Ontario Cancer Registry. Electronic treatment records identified surgical procedures and chemotherapy delivery. This report describes the volume of resections for CRCLM in relation to the incidence of colorectal cancer (CRC). Temporal trends in practice are described during three periods: 1994–1999, 2000–2004, and 2005–2009. Overall survival (OS) and cancer-specific survival (CSS) were measured from the time of lung resection.

Results

A total of 709 patients underwent resection of CRCLM. Between 1994 and 2009, surgical volume increased 190 %, from 1 resection for every 282 incident cases to 1 resection for every 97 incident cases (p < 0.001). The use surgery for CRCLM varied considerably between regions, from 1 resection per 95 incident cases to 1 resection per 212 incident cases (p = 0.021). Use of perioperative chemotherapy increased during study periods, from 22 % (28/130) to 34 % (73/217) to 40 % (146/362; p < 0.001). Utilization rates varied across geographic regions (range 21–59 %; p = 0.005). The OS rate was 40 % [95 % confidence interval (CI) 36–44 %] at 5 years and 27 % (95 % CI 23–31 %) at 10 years. The CSS rate was 42 % (95 % CI 38–46 %) at 5 years and 32 % (95 % CI 27–37 %) at 10 years.

Conclusions

A proportion of patients with resected CRCLM will achieve long-term survival. Outcomes in routine practice are comparable with those reported for high-volume centers. The use of surgery varies considerably across Ontario.

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Acknowledgment

The authors gratefully acknowledge the contributions of Dr. Ryan Fitzpatrick, Janine Biagi and Tina Dyer in the performance of this study. Parts of this material are based on data and information provided by Cancer Care Ontario. However, the analysis, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of Cancer Care Ontario. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this article are those of the authors and independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Dr. Booth had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Booth is supported as a Canada Research Chair in Population Cancer Care. This work also was supported by the Canada Foundation for Innovation and Queen’s University Department of Oncology.

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Authors and Affiliations

  1. Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, ON, Canada

    Christopher M. Booth, Xuejiao Wei & William J. Mackillop

  2. Department of Oncology, Queen’s University, Kingston, ON, Canada

    Christopher M. Booth, Sulaiman Nanji & William J. Mackillop

  3. Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada

    Christopher M. Booth & William J. Mackillop

  4. Department of Surgery, Queen’s University, Kingston, ON, Canada

    Sulaiman Nanji

Authors
  1. Christopher M. Booth
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  2. Sulaiman Nanji
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  4. William J. Mackillop
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Correspondence to Christopher M. Booth.

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Booth, C.M., Nanji, S., Wei, X. et al. Outcomes of Resected Colorectal Cancer Lung Metastases in Routine Clinical Practice: A Population-Based Study. Ann Surg Oncol 23, 1057–1063 (2016). https://doi.org/10.1245/s10434-015-4979-0

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  • DOI: https://doi.org/10.1245/s10434-015-4979-0

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