Treatment of colorectal liver metastases in Germany: a ten-year population-based analysis of 5772 cases of primary colorectal adenocarcinoma

Abstract

BackgroundPurpose 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.MethodsRetrospective analysis of 5772 patients diagnosed with colorectal adenocarcinoma between 2002 and 2007. Follow-up was continued until 2012.Results1426 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.ConclusionsWe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2407-14-810) contains supplementary material, which is available to authorized users.

The Impact of a Hepatobiliary Multidisciplinary Team Assessment in Patients with Colorectal Cancer Liver Metastases: A Population-Based Study

“…This is an optimistic number, but considering that criteria for resection of LM and extrahepatic disease are moving targets, resection rates in this order might be reached in a not too distant future. This is in part supported by other population‐based studies in which an increase in resection rates was observed over time to above 30% in patients diagnosed during 2007 .…”

“…Initially, unresectable liver metastases can be rendered resectable by combinations of tumor‐directed interventions and future liver remnant manipulation . Improvement in imaging technology, surgical and interventional techniques, and oncologic therapy have increased the observed resection rate to approximately 25%, as reported in population‐based materials .…”

Local Treatment of Unresectable Colorectal Liver Metastases: Results of a Randomized Phase II Trial

“…Only 20% to 30% of patients with CRC metastases confined to the liver are candidates for surgery (2,4). In others, extensive tumor burden within the liver or poor anatomical position of the tumors close to critical vascular or biliary structures precludes resection.…”

Treatment sequencing for simultaneous colorectal liver metastases

“…There is no standard definition of “synchronous metastases” in the literature. In clinical trials and population registries, the interval defining “synchronous” metastatic disease generally spans 0 to 12 months after diagnosis . For the purposes of this review, we will refer to the clinical problem as “simultaneous metastases,” that is, known liver metastatic disease at presentation.…”