Population-based study on practice variation regarding preoperative systemic chemotherapy in patients with colorectal liver metastases and impact on short-term outcomes

A.K.E. Elfrink*, N.F.M. Kok, L.R. van der Werf, M.F. Krul, E. Marra, M.W.J.M. Wouters, C. Verhoef, K.F.D. Kuhlmann, M. den Dulk, R.J. Swijnenburg, W.W. te Riele, P.B. van den Boezem, W.K.G. Leclercq, D.J. Lips, V.B. Nieuwenhuijs, P.D. Gobardhan, H.H. Hartgrink, C.I. Buis, D.J. Grunhagen, J.M. KlaaseDutch Hepato Biliary Audit Group

*Corresponding author for this work

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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), 30day 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. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Original languageEnglish
Pages (from-to)1742-1755
Number of pages14
JournalEuropean Journal of Surgical Oncology
Issue number9
Publication statusPublished - 1 Sep 2020


  • cancer
  • cetuximab
  • colorectal liver metastases
  • hepatectomy
  • hepatotoxicity
  • hospital variation
  • neoadjuvant chemotherapy
  • perioperative chemotherapy
  • postoperative outcomes
  • preoperative chemotherapy
  • resectability
  • resection
  • surgery
  • therapy
  • Colorectal liver metastases
  • Preoperative chemotherapy
  • Surgery
  • Hospital variation
  • Postoperative outcomes

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