title: Treatment of colorectal liver metastases in Germany: a ten-year population-based analysis of 5772 cases of primary colorectal adenocarcinoma.
abstract: BACKGROUND
  Purpose of this study was to analyse the surgical management and long-term clinical outcome of patients diagnosed with colorectal liver metastases (CLM) over a period of 10 years using data from a German tumour registry.
  
  
  METHODS
  Retrospective analysis of 5772 patients diagnosed with colorectal adenocarcinoma between 2002 and 2007. Follow-up was continued until 2012.
  
  
  RESULTS
  1426 patients (24.7%) had CLM; 1019 patients (71%) had synchronous, 407 patients (29%) developed metachronous CLM. Hepatic resection was performed in 374 of the 1426 CLM patients (26%). A significant increase in liver resection rate from 16.6% for the 2002 cohort to 32% in later cohorts was observed. In centers specialized in liver surgery, CLM resection rates reached 46.6%. However, up to 52% of patients diagnosed with three or less CLM did not undergo liver surgery, although, if resected, patients with 1 CLM show a similar long-time survival as CRC patients who do not develop any CLM. Univariate and multivariate analyses adjusted for age, sex, year of resection, time of CLM diagnosis and number of CLM revealed a significant survival benefit for CLM resection (HR =0.355; CI 0.305-0.414). Furthermore, significant impact on OS was seen for age at diagnosis, perioperative chemotherapy and number of CLM.
  
  
  CONCLUSIONS
  We here present the first long-term, population-based analysis of the surgical management of CLM in Germany. Significant increase in hepatic resection rates, translating to a significant benefit in OS, was seen over years. However, we still see a striking potential for further improvements in interdisciplinary CLM management.
authors.affiliation: Department of Surgery, University Hospital Regensburg, Franz-Josef Strauss Allee 11, 93053 Regensburg, Germany. Christina.Hackl@ukr.de.
authors.forename: Christina
authors.initials: C
authors.lastname: Hackl
authors.forename: Peter
authors.initials: P
authors.lastname: Neumann
authors.forename: Michael
authors.initials: M
authors.lastname: Gerken
authors.forename: Martin
authors.initials: M
authors.lastname: Loss
authors.forename: Monika
authors.initials: M
authors.lastname: Klinkhammer-Schalke
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schlitt
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012042:Registries; D016896:Treatment Outcome; D055815:Young Adult