The rise in metastasectomy across cancer types over the past decade

Abstract

BACKGROUND: Although studies of metastasectomy have been limited primarily to institutional experiences, reports of favorable long-term outcomes have generated increasing interest. In the current study, the authors attempted to define the national practice patterns in metastasectomy for 4 common malignancies with varying responsiveness to systemic therapy. METHODS: The National (Nationwide) Inpatient Sample was used to estimate the national incidence of metastasectomy for colorectal cancer, lung cancer, breast cancer, and melanoma from 2000 through 2011. Incidence-adjusted rates were determined for liver, lung, brain, small bowel, and adrenal metastasectomies. The average annual percentage change (AAPC) in metastasectomy by cancer type was calculated using joinpoint regression. RESULTS: Colorectal cancer was the most common indication for metastasectomy (87,407 cases; 95% confidence interval [95% CI], 86,307-88,507 cases) followed by lung cancer (58,245 cases; 95% CI, 57,453-59,036 cases), breast cancer (26,271 cases; 95% CI, 25,672-26,870 cases), and melanoma (20,298 cases; 95% CI, 19,897-20,699 cases). Metastasectomy increased significantly for all cancer types over the study period: colorectal cancer (AAPC, 6.83; 95% CI, 5.7-7.9), lung cancer (AAPC, 5.8; 95% CI, 5.1-6.4), breast cancer (AAPC, 5.5; 95% CI, 3.7-7.3), and melanoma (AAPC, 4.03; 95% CI, 2.1-6.0). Despite an increasing number of comorbidities in patients undergoing metastasectomy (P<.05 for each cancer type), inpatient mortality rates after metastasectomy fell for all cancer types, most significantly for colorectal (AAPC, 25.49; 95% CI, 28.2 to 22.7) and lung (AAPC, 26.2; 95% CI, 211.7 to 20.3) cancers. The increasing performance of metastasectomy was largely driven by high-volume institutions, in which patients had a lower mean number of comorbidities (P<.01 for all cancer types) and lower inpatient mortality (P<.01 for all cancers except melanoma). CONCLUSIONS: From 2000 through 2011, the performance of metastasectomy increased substantially across common cancer types, notwithstanding various advances in systemic therapies. Metastasectomy was performed more safely, despite increasing patient comorbidity. High-volume institutions appeared to drive practice patterns. Cancer 2015;121:747-57. V C 2014 American Cancer Society.KEYWORDS: metastasectomy, colorectal cancer metastasectomy, lung cancer metastasectomy, breast cancer metastasectomy, melanoma metastasectomy, surgical trends. INTRODUCTIONHistorically, the role of surgery in patients with metastatic cancer was predominately limited to palliative or emergent operations. By the 1980s, however, a few centers were consistently performing surgical resections for select patients with metastatic cancer and reporting promising results. [1][2][3] In addition, theories of cancer biology began to suggest that in a subset of patients, oligometastatic disease might indeed represent the entire clinically relevant disease burden. 4 In these cases, complete resection was associated with prolonged disease-free s...

New Strategies in Stereotactic Radiotherapy for Oligometastases

“…In the United States, although operative mortality rates are improving, the average inpatient mortality rates after metastectomy for colorectal, lung, and breast cancers in 2011 were 1.5% to 2.5%. Mortality rates are approximately 2-fold higher at low-volume hospitals than at high-volume centers (24). A mortality rate of 4% (e.g., at a low-volume hospital or in a high-risk procedure) results in a number needed to harm (NNH) of 25.…”

“…Between 2000 and 2011, metastectomy rates for colorectal cancer, lung cancer, breast cancer, and melanoma in the United States increased at an average annual percentage rate of 4% to 6% per year (24). In Europe, pulmonary metastectomy now represents 15% to 50% of the workload of thoracic surgical departments (25).…”

Blockade of LAG3 enhances responses of tumor-infiltrating T cells in mismatch repair-proficient liver metastases of colorectal cancer

“…1-3 More than 50% of CRC patients develop metastatic disease to their liver over the course of their life, 4 and liver metastasis is a leading cause of death from CRC. 5-7 Unfortunately, surgical resection of isolated liver metastases of CRC (LM-CRC) is curative in only 20%-30% of patients, 8 , 9 and systemic therapy provides limited survival benefit. 10 Patients with unresectable LM-CRC have a poor prognosis with a median survival of only two years.…”

A multi-national report on stereotactic body radiotherapy for oligometastases: Patient selection and follow-up*

“…Whereas such treatments were once reserved for palliation, today surgery, SBRT, and interventional radiological procedures are applied with rapidly increasing frequency with the hopes that they will improve patient outcomes [12][13][14]. SBRT is an attractive option because it can be used on a wide variety of targets, it is typically a non-invasive, convenient outpatient procedure, and advanced radiation technology and expertise are now readily available throughout most modern health systems.…”