Population-based study on practice variation regarding preoperative systemic chemotherapy in patients with colorectal liver metastases and impact on short-term outcomes |
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| Affiliation: | 2. Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands;5. Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands;6. Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands;10. Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands;11. Department of Surgery, Isala, Zwolle, the Netherlands;1. Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands;3. Department of Surgery, Antoni van Leeuwenhoek, Amsterdam, the Netherlands;4. Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, the Netherlands;7. Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands;8. Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands;9. Department of Surgery, Máxima Medical Centre, Eindhoven / Veldhoven, the Netherlands;12. Department of Surgery, Amphia Hospital, Breda, the Netherlands;13. Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands;1. Department of Radiation Oncology, University of Louisville Hospital, Louisville, KY, USA;2. Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA;3. College of Arts and Sciences, Cornell University, Ithaca, NY, USA;1. Department of Hematology, National Cancer Center Hospital East, Chiba, Japan;2. JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan;3. Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan;4. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan;5. Oita University, Oita, Japan;6. Department of Surgery, Tochigi Cancer Center, Tochigi, Japan;7. Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan;1. Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, The Netherlands;2. Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands;3. Department of Surgery, St. Elisabeth Hospital Tilburg, PO Box 90151, 5000 LC Tilburg, The Netherlands;4. Department of Public Health, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands;5. Department of Radiology, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS Nijmegen, The Netherlands;6. Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, 5000 LE Tilburg, The Netherlands;1. Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands;2. Department of Surgery, Antoni van Leeuwenhoek-National Cancer Institute, Amsterdam, the Netherlands;3. Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands;4. School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands;5. Department of Surgery, IJsselland Hospital, Capelle a/d IJssel, the Netherlands;6. Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands;7. Department of Surgery, Haaglanden Medisch Centrum, Hague, the Netherlands;8. Department of Radiotherapy, Antoni van Leeuwenhoek-National Cancer Institute, Amsterdam, the Netherlands;9. Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands;10. Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands;1. Department of GI and HPB Oncosurgery, Rajiv Gandhi Cancer Institute & Research Centre, Sector -5, Rohini, Delhi, 110085, India;2. Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute & Reserach Centre, Delhi, India;3. Department of Imaging and Radiodiagnosis, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India;1. Clinica Chirurgica I, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy;2. Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy;3. Clinical Research Unit, Istituto Oncologico Veneto IOV – IRCCS, Padova, Italy |
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| Abstract: | IntroductionDefinitions 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 methodsAll 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.ResultsIn 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.ConclusionSignificant 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. |
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| Keywords: | Colorectal liver metastases Preoperative chemotherapy Surgery Postoperative outcomes Hospital variation |
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