Changing trends in the presentation of colorectal liver metastases in a single hepatobiliary tertiary referral centre over fourteen years.
OBJECTIVE
National Institute for Clinical Excellence guidelines suggest that patients who have undergone potentially curative treatment for colorectal cancer (CRC) should be followed up for 3 years. The aim of this study was to investigate whether the time to presentation with colorectal liver metastases (CRLM) has changed over time. This information, which is currently unknown, may inform future decisions regarding follow-up.


METHODS
Patients presenting with metachronous isolated liver metastases between 1997 and 2011 were included. Timings of presentation with CRLM, rates of liver resection, survival data and factors associated with delayed presentation were investigated.


RESULTS
269 patients were included in the study. Those having their primary CRC resection between 1997 and 2007 presented earlier with liver metastases over time (r = -0.33, 95% CI -0.45 to -0.20). However, 26% of patients who developed CRLM did so beyond 3 years. There was no significant difference in rates of liver resections for those presenting within, or beyond, 3 years (p = 0.21). There was no significant difference in survival for those presenting with resectable CRLM within, or beyond, 3 years (Exp(b) = 0.60, 95% CI 0.28-1.28). No factors associated with late presentation were identified.


CONCLUSIONS
These results suggest that CRC follow-up should be extended to 5 years. Follow-up interventions should be more frequent in the early stages reflecting the trend towards earlier presentation with CRLM. The economic implications of extending follow-up compare favourably to other NHS funded initiatives.
Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK. Electronic address: sarah.thomasset@uhl-tr.nhs.uk.
S C
SC
Thomasset
A R
AR
Dennison
M S
MS
Metcalfe
W P
WP
Steward
G
G
Garcea
D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D017048:Health Care Costs; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology* / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
Colorectal neoplasms; Liver; Neoplasm metastasis