Population-based study on practice variation regarding preoperative systemic chemotherapy in patients with colorectal liver metastases and impact on short-term outcomes. Issue 9 (September 2020)

• Record Type: Journal Article
• Authors: Elfrink, Arthur K.E.; Kok, Niels F.M.; van der Werf, Leonie R.; Krul, Myrtle F.; Marra, Elske; Wouters, Michel W.J.M.; Verhoef, Cornelis; Kuhlmann, Koert F.D.; den Dulk, Marcel; Swijnenburg, Rutger-Jan; te Riele, Wouter W.; van den Boezem, Peter B.; Leclercq, Wouter K.G.; Lips, Daan J.; Nieuwenhuijs, Vincent B.; Gobardhan, Paul D.; Hartgrink, Henk H.; Buis, Carlijn I.; Grünhagen, Dirk J.; Klaase, Joost M.; de Boer, Marieke T.; Besselink, Marc G.H.; Dejong, Cees H.C.; van Gulik, Thomas H.; Hagendoorn, Jeroen; Hoogwater, Frederik J.H.; Liem, Mike S.L.; Molenaar, I. Quintus; Patijn, Gijs A.; Bosscha, Koop; Belt, Eric J.Th; Vermaas, Maarten; Gerhards, Michael F.; van Heek, N.T.; Oosterling, Steven J.; Torrenga, Hans; Eker, Hasan H.; Consten, Esther C.J.; van Duijvendijk, Peter;
• Is Part Of: European journal of surgical oncology. Volume 46:Issue 9(2020)
• Page Start: 1742
• Page End: 1755
• Publication Date: 2020-09
• Subjects: Colorectal liver metastases -- Preoperative chemotherapy -- Surgery -- Postoperative outcomes -- Hospital variation; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.03.221
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: Definitions regarding resectability and hence indications for preoperative chemotherapy vary. Use of preoperative chemotherapy may influence postoperative outcomes. This study aimed to assess the variation in use of preoperative chemotherapy for CRLM and related postoperative outcomes in the Netherlands. Materials and methods: All patients who underwent liver resection for CRLM in the Netherlands between 2014 and 2018 were included from a national database. Case-mix factors contributing to the use of preoperative chemotherapy, hospital variation and postoperative outcomes were assessed using multivariable logistic regression. Postoperative outcomes were postoperative complicated course (PCC), 30-day morbidity and 30-day mortality. Results: In total, 4469 patients were included of whom 1314 patients received preoperative chemotherapy and 3155 patients did not. Patients receiving chemotherapy were significantly younger (mean age (+SD) 66.3 (10.4) versus 63.2 (10.2) p < 0.001) and had less comorbidity (Charlson scores 2+ (24% versus 29%, p = 0.010). Unadjusted hospital variation concerning administration of preoperative chemotherapy ranged between 2% and 55%. After adjusting for case-mix factors, three hospitals administered significantly more preoperative chemotherapy than expected and six administered significantly less preoperative chemotherapy than expected. PCC was 12.1%, 30-day morbidity was 8.8% and 30-day mortality was 1.5%. No association between preoperative chemotherapy and PCC (OR 1.24, 0.98–1.55, p = 0.065), 30-day morbidity (OR 1.05, 0.81–1.39, p = 0.703) or with 30-day mortality (OR 1.22, 0.75–2.09, p = 0.467) was found. Conclusion: Significant hospital variation in the use of preoperative chemotherapy for CRLM was present in the Netherlands. No association between postoperative outcomes and use of preoperative chemotherapy was found.