Surgery for Colorectal Liver Metastases

McNally, Steve; Parks, Rowan W.

doi:10.1159/000351442

Cited by 34 publications

(30 citation statements)

References 101 publications

(105 reference statements)

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“…1 Despite this, surgical resection of metastatic sites of disease remains the only potentially curative therapy. 2–5 Five-year survival rates of 40% and as high as 54% in selected patients have been reported with pulmonary and liver metastasectomy. 6–8 Although improved survival has been demonstrated with metastatic site resection, uptake of aggressive surgical approaches remains low among certain patients.…”

Section: Introductionmentioning

confidence: 99%

Insurance Status and Hospital Payer Mix Are Linked With Variation in Metastatic Site Resection in Patients With Advanced Colorectal Cancers

Healy

Pradarelli

Krell

et al. 2016

Diseases of the Colon &Amp; Rectum

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Background Despite substantially improved survival with metastatic site resection in colorectal cancers, uptake of aggressive surgical approaches remains low among certain patients. It is unknown whether financial determinants of care, such as insurance status, play a role in this treatment gap. Objective We sought to evaluate the effect of insurance status on metastasectomy in patients with advanced colorectal cancers. Methods Using the National Cancer Data Base Participant User File, incident cases of colorectal cancer metastatic to the lung and/or liver with diagnosis from 2010 – 2013, were identified. Controlling for patient, tumor, and hospital characteristics, hierarchical regression was used to examine associations between hospital payer mix and metastatic site resection. Results We identified 42,300 patients in our cohort with mean age 64 years. Metastatic site resection occurred in 12.3% of all patients. Adjusting for patient and hospital fixed effects, we found that patients who were uninsured or on Medicaid were 38% less likely to undergo metastasectomy (OR, 0.62; 95% CI, 0.56 – 0.66). Patients in hospitals treating a high percentage of uninsured or Medicaid patients were less likely to undergo metastasectomy, even after controlling for individual patient insurance status. Limitations The study was limited by its retrospective design and the granularity and accuracy of the National Cancer Data Base. Conclusion Differences in insurance status and hospital payer mix are associated with differences in rates of metastatic site resection in patients with colorectal cancer that is metastatic to the lung and/or liver. There is a need for improved access to metastatic site resection for individual patients who are uninsured or who have Medicaid insurance, and for all patients who seek care at hospitals treating a large proportion of uninsured or Medicaid patients. Remedies for individual patients could include improved access to private insurance through employment or individual plans or improved reimbursement from Medicaid for this procedure. Strategies for patients at low-performing hospitals include selective referral to centers that perform mestastectomy more frequently when appropriate.

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Section: Introductionmentioning

confidence: 99%

Insurance Status and Hospital Payer Mix Are Linked With Variation in Metastatic Site Resection in Patients With Advanced Colorectal Cancers

Healy

Pradarelli

Krell

et al. 2016

Diseases of the Colon &Amp; Rectum

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“…However, they defined metastatic involvement on CT differently depending on position of the nodal station. Portocaval nodes were considered involved if cross product of dimensions was ≥0.65 cm 2 . Pancreaticoduodenal and hepatic artery nodes were considered involved as long as CT could detect them.…”

Section: Definition Of Lymph Node Involvementmentioning

confidence: 99%

“…About 50% of patients with colorectal carcinoma will eventually develop metastases, with liver and lungs being the most common sites [2] [3] [4] [5] [6]. For patients with liver metastases, surgery remains the gold standard of treatment with 5-year survival rates approaching 50% [6]- [11].…”

mentioning

confidence: 99%

Pre-Operative Perihepatic Lymph Node Assessment in Colorectal Cancer Liver Metastasis—A Review of Current Literature

Yong¹,

Burrows²,

Christophi³

2017

OJMI

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Objective: Perihepatic lymph node involvement in colorectal cancer liver metastases is a negative prognostic factor. Resection of certain nodal stations around the liver has been shown to possibly improve survival. The aim of this review is to interrogate current literature on pre-operative investigations in diagnosing lymph node involvement. Method: A systematic review was conducted of articles published since 2006 to determine usefulness of pre-operative imaging in diagnosing lymph node involvement in colorectal cancer liver metastases. Results: Only 2 papers met the inclusion criteria for this study. Computed tomography (CT) scans were found to have sensitivities of 33% and 40%, specificities of 94% and 92%, positive predictive values (PPV) of 56% and 30%, and negative predictive values (NPV) of 85% and 95%. Positron emission tomography (PET) was studied in one of the paper and was found to have sensitivity, specificity, PPV and NPV of 57%, 100%, 100%, and 88% respectively. Conclusion: There is a significant lack of research on pre-operative investigations of perihepatic lymph node involvement in colorectal cancer liver metastases. Pre-operative CT and PET scans in assessing perihepatic lymph nodes were shown to be inaccurate. Newer pre-operative imaging modalities and research would be needed.

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“…Nowadays, patients with liver metastases are treated with neoadjuvant chemotherapy and then undergo local resection [4]. This treatment has a 5-year survival rate of 30–58%, with a high rate of recurrence [3, 4, 5, 6]. If the metastases are unresectable, the survival rate does not exceed 2% [4].…”

Section: Introductionmentioning

confidence: 99%

Liver Transplantation for Unresectable Metastases from Colon Adenocarcinoma

Caicedo

Buitrago

Thomas

et al. 2017

Case Rep Gastroenterol

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Liver transplantation is an option that improves quality of life and prolongs life expectancy in patients with different types of liver disease. Liver transplantation is controversial for colorectal metastases and is not recommended in clinical practice guidelines. In this case report, we present, to our knowledge, the first liver transplantation for colorectal metastases conducted in Colombia, with a successful follow-up of more than 2 years. Patients with these characteristics who underwent liver transplantation experience reduced mortality and exponentially improved quality of life.

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Surgery for Colorectal Liver Metastases

Cited by 34 publications

References 101 publications

Insurance Status and Hospital Payer Mix Are Linked With Variation in Metastatic Site Resection in Patients With Advanced Colorectal Cancers

Insurance Status and Hospital Payer Mix Are Linked With Variation in Metastatic Site Resection in Patients With Advanced Colorectal Cancers

Pre-Operative Perihepatic Lymph Node Assessment in Colorectal Cancer Liver Metastasis—A Review of Current Literature

Liver Transplantation for Unresectable Metastases from Colon Adenocarcinoma

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