title: Long-term global quality of life in patients treated for colorectal liver metastases.
abstract: BACKGROUND
  Surgical treatment of colorectal liver metastases has become increasingly aggressive. The influence of this more active surgical approach on patients' health-related quality of life (HRQoL) has hardly been evaluated. This study investigated the impact of surgical and systemic treatment on HRQoL in patients undergoing hepatic resection for colorectal metastases.
  
  
  METHODS
  A total of 145 patients with colorectal liver metastases were entered prospectively into the study. Based on HRQoL values derived from the EuroQol-5D, health summary measures were calculated to express the overall impact on four distinct clinical states. The HRQoL instrument was used at baseline, 3 and 6 weeks after surgery, and every 3 months thereafter for up to 3 years.
  
  
  RESULTS
  Patients showed a clear deterioration in HRQoL in the first weeks after surgery, followed by a recovery to baseline levels at 3 months after potentially curative surgery. In contrast, a sustained decline was noted when initial surgery for colorectal liver metastases was considered futile and palliative chemotherapy was started immediately. Three years after initial surgery, there were distinct differences in HRQoL between patients with or without recurrence. The latter group still had HRQoL scores at baseline levels, whereas patients with tumour recurrence showed a significant deterioration in HRQoL. Remarkably, there was no decline in HRQoL in patients with recurrent disease who could be treated by secondary surgical intervention.
  
  
  CONCLUSIONS
  Superior overall HRQoL in the first 3 years after initial successful surgical intervention merits an aggressive surgical approach and intensive follow-up to detect recurrence early.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. b.wiering@chir.umcn.nl
authors.forename: B
authors.initials: B
authors.lastname: Wiering
authors.forename: W J G
authors.initials: WJ
authors.lastname: Oyen
authors.forename: E M M
authors.initials: EM
authors.lastname: Adang
authors.forename: J R M
authors.initials: JR
authors.lastname: van der Sijp
authors.forename: R M
authors.initials: RM
authors.lastname: Roumen
authors.forename: K P
authors.initials: KP
authors.lastname: de Jong
authors.forename: T J M
authors.initials: TJ
authors.lastname: Ruers
authors.forename: P F M
authors.initials: PF
authors.lastname: Krabbe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015179:Colorectal Neoplasms / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years