Survival after hepatic resection of colorectal cancer metastases: a national experience.
BACKGROUND
Most estimates of short- and long-term survival after hepatic resection of colorectal cancer metastases are derived from surgical case series. For the current report, the authors used Medicare data to investigate operative mortality and long-term survival in a national sample and examined the factors associated with survival.


METHODS
Data were analyzed from Medicare enrollees (age >or=65 years) who were admitted to hospital between January 1, 2000 and December 31, 2004 with a primary diagnosis of colorectal cancer with resection. The sample was restricted to patients who subsequently underwent hepatic resection for liver metastases. The Medicare Denominator File was used to determine operative mortality and long-term survival and the factors that were associated with those outcomes.


RESULTS
Of the 306,061 Medicare beneficiaries who were diagnosed with colorectal cancer, 3957 patients were identified who underwent hepatic resection for liver metastases. The crude 30-day and 90-day mortality rates were 4% and 8.2%, respectively, and the 5-year survival rate was 25.5%. Advancing age (hazards ratio [HR], 1.83; 95% confidence interval [95% CI], 1.32-2.53 for age >or=80 years vs ages 65-69 years), comorbid disease (HR, 1.40; 95% CI, 1.06-1.85 for Charlson >or=5 vs Charlson 0), and synchronous colon/hepatic resection (HR, 2.46; 95% CI, 1.89-3.20 for synchronous vs metachronous resection) were associated with worse 90-day mortality. Similarly, long-term mortality was associated with age (HR, 1.36; 95% CI, 1.18-1.56), comorbid disease (HR, 1.51; 95% CI, 1.36-1.69), and synchronous colon/hepatic resection (HR, 1.37; 95% CI, 1.24-1.51 for synchronous vs metachronous resection).


CONCLUSIONS
In this national study, short- and long-term survival was worse than that reported in surgical case series. Subgroups at high risk for worse outcomes include the extreme elderly and those undergoing synchronous colon and hepatic resection.
Robertson
Douglas J
DJ
Veterans Affairs Outcomes Group, Veterans Affairs Medical Center, White River Junction, Vermont 05009, USA. douglas.robertson@med.va.gov
Stukel
Therese A
TA
Gottlieb
Daniel J
DJ
Sutherland
Jason M
JM
Fisher
Elliott S
ES
D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology