title: From scratch: developing a hepatic resection service for metastatic colorectal cancer.
abstract: BACKGROUND
  Waitemata District Health Board has New Zealand's largest catchment and busiest colorectal unit. The upper gastrointestinal unit was established in 2005, in part to provide a hepatic resection service for patients with colorectal carcinoma metastatic to the liver. The aim of this investigation was to report on quality indicators for the hepatic resection of colorectal carcinoma in the development of a regional resection service.
  
  
  METHODS
  Prospectively collected data on patients undergoing hepatic resection for colorectal carcinoma between 2005 and 2014 was reviewed and correlated with costing data and national hepatic resection rates.
  
  
  RESULTS
  A total of 123 patients underwent 138 hepatic resections for metastatic colorectal cancer with a median hospital stay of 8 days (range 4-37 days), a zero 30-day mortality and a median cost of NZ$21 374 for minor hepatectomy and NZ$43 133 for major hepatectomy. Actuarial 5-year disease-free survival was 44%, with 28 patients alive and disease free at 5 years post-resection. Median overall survival was not reached. Review of national hepatic resection rates indicate that Waitemata District Health Board performs one sixth of all hepatic resections in New Zealand and that this treatment modality may be underutilized in the management of patients with metastatic colorectal cancer.
  
  
  CONCLUSIONS
  A regional hepatic resection centre for colorectal metastases can be established in areas of population need and can provide a high-quality, cost-effective service.
authors.affiliation: Upper Gastrointestinal Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand.
authors.forename: Neil
authors.initials: N
authors.lastname: Wylie
authors.affiliation: Department of Population Health, University of Otago, Christchurch, New Zealand.
authors.forename: Phillip
authors.initials: P
authors.lastname: Hider
authors.affiliation: Upper Gastrointestinal Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand.
authors.forename: Delwyn
authors.initials: D
authors.lastname: Armstrong
authors.affiliation: Upper Gastrointestinal Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand.
authors.forename: Kheman
authors.initials: K
authors.lastname: Rajkomar
authors.affiliation: Upper Gastrointestinal Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand.
authors.forename: Sanket
authors.initials: S
authors.lastname: Srinivasa
authors.affiliation: Upper Gastrointestinal Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand.
authors.forename: Michael
authors.initials: M
authors.lastname: Rodgers
authors.affiliation: Upper Gastrointestinal Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand.
authors.forename: Anna
authors.initials: A
authors.lastname: Brown
authors.affiliation: Upper Gastrointestinal Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Koea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000078336:Facilities and Services Utilization; D005260:Female; D017048:Health Care Costs; D006498:Hepatectomy / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data*; D009520:New Zealand; D061646:Operative Time; D000078337:Procedures and Techniques Utilization; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012040:Regional Health Planning
keywords: New Zealand; colorectal cancer; hepatectomy; quality; regionalization