title: Surgical resection and peri-operative chemotherapy for colorectal cancer liver metastases: A population-based study.
abstract: BACKGROUND
  Most literature describing surgery for colorectal cancer (CRC) liver metastases (LM) comes from high volume centres. Here, we report management and outcomes achieved in routine clinical practice.
  
  
  METHODS
  All cases of CRC in Ontario who underwent resection of LM in 1994-2009 were identified using the population-based Ontario Cancer Registry. Electronic treatment records identified chemotherapy delivery. Temporal trends are described for 3 periods: 1994-1999, 2000-2004, 2005-2009. We describe volume of resected CRCLM as a ratio of incident cases per CRCLM resection. Overall (OS) and cancer-specific survival (CSS) are measured from time of LM resection.
  
  
  RESULTS
  2717 patients underwent resection of CRCLM. Between 1994 and 2009 there was a 78% increase in case volume; from one resection for every 48 incident cases to one resection for every 27 incident cases, p < 0.001. Use of peri-operative chemotherapy increased over study periods from 44% (306/700), to 52% (429/830), to 65% (777/1187, p < 0.001). Chemotherapy utilization rates varied across geographic regions (range 43%-69%, p < 0.001). Post-operative mortality rates at 30 and 90 days were 2.5% and 4.3% respectively. Five year OS during the study periods was 36% (95% CI 32-39%), 40% (95% CI 36-43%), and 46% (95% CI 43-49%) (p < 0.001); CSS was 38% (95% CI 35-42%), 42% (95% CI 38-45%), 49% (95% CI 44-53%) (p < 0.001). The temporal improvement in OS/CSS persisted on adjusted analyses.
  
  
  CONCLUSIONS
  Outcomes of patients with resected CRCLM in routine practice is comparable to those reported from high volume centres. Survival improved over the study period despite a greater proportion of patients with CRC undergoing liver resection.
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, Canada; Department of Oncology, Queen's University, Kingston, Canada; Department of Public Health Sciences, Queen's University, Kingston, Canada. Electronic address: boothc@kgh.kari.net.
authors.forename: C M
authors.initials: CM
authors.lastname: Booth
authors.affiliation: Department of Oncology, Queen's University, Kingston, Canada; Department of Surgery, Queen's University, Kingston, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Nanji
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, Canada.
authors.forename: X
authors.initials: X
authors.lastname: Wei
authors.affiliation: Department of Oncology, Queen's University, Kingston, Canada.
authors.forename: J J
authors.initials: JJ
authors.lastname: Biagi
authors.affiliation: Princess Margaret Cancer Centre, Toronto, Canada.
authors.forename: M K
authors.initials: MK
authors.lastname: Krzyzanowska
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, Canada; Department of Oncology, Queen's University, Kingston, Canada; Department of Public Health Sciences, Queen's University, Kingston, Canada.
authors.forename: W J
authors.initials: WJ
authors.lastname: Mackillop
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000556:secondary / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data* / Q000639:trends; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D019990:Perioperative Care; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Colorectal cancer; Health services research; Metastases; Outcomes; Surgery