Hospital variation and outcomes of simultaneous resection of primary colorectal tumour and liver metastases: a population-based study

Myrtle F Krul; Arthur K E Elfrink; Carlijn I Buis; Rutger-Jan Swijnenburg; Wouter W Te Riele; Cornelis Verhoef; Paul D Gobardhan; Marcel den Dulk; Mike S L Liem; Pieter J Tanis; J S D Mieog; Peter B van den Boezem; Wouter K G Leclercq; Vincent B Nieuwenhuijs; Michael F Gerhards; Joost M Klaase; Dirk J Grünhagen; Niels F M Kok; Koert F D Kuhlmann; Collaborators

doi:10.1016/j.hpb.2021.06.422

Hospital variation and outcomes of simultaneous resection of primary colorectal tumour and liver metastases: a population-based study

Myrtle F Krul^*, Arthur K E Elfrink, Carlijn I Buis, Rutger-Jan Swijnenburg, Wouter W Te Riele, Cornelis Verhoef, Paul D Gobardhan, Marcel den Dulk, Mike S L Liem, Pieter J Tanis, J S D Mieog, Peter B van den Boezem, Wouter K G Leclercq, Vincent B Nieuwenhuijs, Michael F Gerhards, Joost M Klaase, Dirk J Grünhagen, Niels F M Kok, Koert F D Kuhlmann, Collaborators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: The optimal treatment sequence for patients with synchronous colorectal liver metastases (CRLM) remains uncertain. This study aimed to assess factors associated with the use of simultaneous resections and impact on hospital variation.

METHOD: This population-based study included all patients who underwent liver surgery for synchronous colorectal liver metastases between 2014 and 2019 in the Netherlands. Factors associated with simultaneous resection were identified. Short-term surgical outcomes of simultaneous resections and factors associated with 30-day major morbidity were evaluated.

RESULTS: Of 2146 patients included, 589 (27%) underwent simultaneous resection in 28 hospitals. Simultaneous resection was associated with age, sex, BMI, number, size and bilobar distribution of CRLM, and administration of preoperative chemotherapy. More minimally invasive and minor resections were performed in the simultaneous group. Hospital variation was present (range 2.4%-83.3%) with several hospitals performing simultaneous procedures more and less frequently than expected. Simultaneous resection resulted in 13% 30-day major morbidity, and 1% mortality. ASA classification ≥3 was independently associated with higher 30-day major morbidity after simultaneous resection (aOR 1.97, CI 1.10-3.42, p = 0.018).

CONCLUSION: Distinctive patient and tumour characteristics influence the choice for simultaneous resection. Remarkable hospital variation is present in the Netherlands.

Original language	English
Pages (from-to)	255-266
Number of pages	12
Journal	HPB
Volume	24
Issue number	2
Early online date	10 Jul 2021
DOIs	https://doi.org/10.1016/j.hpb.2021.06.422
Publication status	Published - Feb 2022

Keywords

CANCER
SURGERY

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10.1016/j.hpb.2021.06.422Licence: Free access - publisher

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Krul, M. F., Elfrink, A. K. E., Buis, C. I., Swijnenburg, R.-J., Te Riele, W. W., Verhoef, C., Gobardhan, P. D., Dulk, M. D., Liem, M. S. L., Tanis, P. J., Mieog, J. S. D., van den Boezem, P. B., Leclercq, W. K. G., Nieuwenhuijs, V. B., Gerhards, M. F., Klaase, J. M., Grünhagen, D. J., Kok, N. F. M., Kuhlmann, K. F. D., & Collaborators (2022). Hospital variation and outcomes of simultaneous resection of primary colorectal tumour and liver metastases: a population-based study. HPB, 24(2), 255-266. https://doi.org/10.1016/j.hpb.2021.06.422

@article{d0eacfaca7be42ceab153bd196e5bf47,

title = "Hospital variation and outcomes of simultaneous resection of primary colorectal tumour and liver metastases: a population-based study",

abstract = "BACKGROUND: The optimal treatment sequence for patients with synchronous colorectal liver metastases (CRLM) remains uncertain. This study aimed to assess factors associated with the use of simultaneous resections and impact on hospital variation.METHOD: This population-based study included all patients who underwent liver surgery for synchronous colorectal liver metastases between 2014 and 2019 in the Netherlands. Factors associated with simultaneous resection were identified. Short-term surgical outcomes of simultaneous resections and factors associated with 30-day major morbidity were evaluated.RESULTS: Of 2146 patients included, 589 (27%) underwent simultaneous resection in 28 hospitals. Simultaneous resection was associated with age, sex, BMI, number, size and bilobar distribution of CRLM, and administration of preoperative chemotherapy. More minimally invasive and minor resections were performed in the simultaneous group. Hospital variation was present (range 2.4%-83.3%) with several hospitals performing simultaneous procedures more and less frequently than expected. Simultaneous resection resulted in 13% 30-day major morbidity, and 1% mortality. ASA classification ≥3 was independently associated with higher 30-day major morbidity after simultaneous resection (aOR 1.97, CI 1.10-3.42, p = 0.018).CONCLUSION: Distinctive patient and tumour characteristics influence the choice for simultaneous resection. Remarkable hospital variation is present in the Netherlands.",

keywords = "CANCER, SURGERY",

author = "Krul, {Myrtle F} and Elfrink, {Arthur K E} and Buis, {Carlijn I} and Rutger-Jan Swijnenburg and {Te Riele}, {Wouter W} and Cornelis Verhoef and Gobardhan, {Paul D} and Dulk, {Marcel den} and Liem, {Mike S L} and Tanis, {Pieter J} and Mieog, {J S D} and {van den Boezem}, {Peter B} and Leclercq, {Wouter K G} and Nieuwenhuijs, {Vincent B} and Gerhards, {Michael F} and Klaase, {Joost M} and Gr{\"u}nhagen, {Dirk J} and Kok, {Niels F M} and Kuhlmann, {Koert F D} and Collaborators",

year = "2022",

month = feb,

doi = "10.1016/j.hpb.2021.06.422",

language = "English",

volume = "24",

pages = "255--266",

journal = "HPB",

issn = "1365-182X",

publisher = "ELSEVIER SCI LTD",

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Krul, MF, Elfrink, AKE, Buis, CI, Swijnenburg, R-J, Te Riele, WW, Verhoef, C, Gobardhan, PD, Dulk, MD, Liem, MSL, Tanis, PJ, Mieog, JSD, van den Boezem, PB, Leclercq, WKG, Nieuwenhuijs, VB, Gerhards, MF, Klaase, JM, Grünhagen, DJ, Kok, NFM, Kuhlmann, KFD & Collaborators 2022, 'Hospital variation and outcomes of simultaneous resection of primary colorectal tumour and liver metastases: a population-based study', HPB, vol. 24, no. 2, pp. 255-266. https://doi.org/10.1016/j.hpb.2021.06.422

TY - JOUR

T1 - Hospital variation and outcomes of simultaneous resection of primary colorectal tumour and liver metastases

T2 - a population-based study

AU - Krul, Myrtle F

AU - Elfrink, Arthur K E

AU - Buis, Carlijn I

AU - Swijnenburg, Rutger-Jan

AU - Te Riele, Wouter W

AU - Verhoef, Cornelis

AU - Gobardhan, Paul D

AU - Dulk, Marcel den

AU - Liem, Mike S L

AU - Tanis, Pieter J

AU - Mieog, J S D

AU - van den Boezem, Peter B

AU - Leclercq, Wouter K G

AU - Nieuwenhuijs, Vincent B

AU - Gerhards, Michael F

AU - Klaase, Joost M

AU - Grünhagen, Dirk J

AU - Kok, Niels F M

AU - Kuhlmann, Koert F D

AU - Collaborators

PY - 2022/2

Y1 - 2022/2

N2 - BACKGROUND: The optimal treatment sequence for patients with synchronous colorectal liver metastases (CRLM) remains uncertain. This study aimed to assess factors associated with the use of simultaneous resections and impact on hospital variation.METHOD: This population-based study included all patients who underwent liver surgery for synchronous colorectal liver metastases between 2014 and 2019 in the Netherlands. Factors associated with simultaneous resection were identified. Short-term surgical outcomes of simultaneous resections and factors associated with 30-day major morbidity were evaluated.RESULTS: Of 2146 patients included, 589 (27%) underwent simultaneous resection in 28 hospitals. Simultaneous resection was associated with age, sex, BMI, number, size and bilobar distribution of CRLM, and administration of preoperative chemotherapy. More minimally invasive and minor resections were performed in the simultaneous group. Hospital variation was present (range 2.4%-83.3%) with several hospitals performing simultaneous procedures more and less frequently than expected. Simultaneous resection resulted in 13% 30-day major morbidity, and 1% mortality. ASA classification ≥3 was independently associated with higher 30-day major morbidity after simultaneous resection (aOR 1.97, CI 1.10-3.42, p = 0.018).CONCLUSION: Distinctive patient and tumour characteristics influence the choice for simultaneous resection. Remarkable hospital variation is present in the Netherlands.

AB - BACKGROUND: The optimal treatment sequence for patients with synchronous colorectal liver metastases (CRLM) remains uncertain. This study aimed to assess factors associated with the use of simultaneous resections and impact on hospital variation.METHOD: This population-based study included all patients who underwent liver surgery for synchronous colorectal liver metastases between 2014 and 2019 in the Netherlands. Factors associated with simultaneous resection were identified. Short-term surgical outcomes of simultaneous resections and factors associated with 30-day major morbidity were evaluated.RESULTS: Of 2146 patients included, 589 (27%) underwent simultaneous resection in 28 hospitals. Simultaneous resection was associated with age, sex, BMI, number, size and bilobar distribution of CRLM, and administration of preoperative chemotherapy. More minimally invasive and minor resections were performed in the simultaneous group. Hospital variation was present (range 2.4%-83.3%) with several hospitals performing simultaneous procedures more and less frequently than expected. Simultaneous resection resulted in 13% 30-day major morbidity, and 1% mortality. ASA classification ≥3 was independently associated with higher 30-day major morbidity after simultaneous resection (aOR 1.97, CI 1.10-3.42, p = 0.018).CONCLUSION: Distinctive patient and tumour characteristics influence the choice for simultaneous resection. Remarkable hospital variation is present in the Netherlands.

KW - CANCER

KW - SURGERY

U2 - 10.1016/j.hpb.2021.06.422

DO - 10.1016/j.hpb.2021.06.422

M3 - Article

C2 - 34305003

SN - 1365-182X

VL - 24

SP - 255

EP - 266

JO - HPB

JF - HPB

IS - 2

ER -