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 2 146 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% to 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).

Discussion

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

中文翻译：

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原发性结直肠肿瘤和肝转移同时切除的医院变异和结果：一项基于人群的研究

背景

同步结直肠肝转移（CRLM）患者的最佳治疗顺序仍不确定。本研究旨在评估与使用同步切除术相关的因素以及对医院变异的影响。

方法

这项基于人群的研究纳入了 2014 年至 2019 年间在荷兰因同步结直肠肝转移而接受肝脏手术的所有患者。确定了与同时切除相关的因素。评估了同时切除的短期手术结果和与 30 天主要发病率相关的因素。

结果

在纳入的 2 146 名患者中，589 名（27%）在 28 家医院接受了同步切除术。同时切除与年龄、性别、BMI、CRLM的数量、大小和双叶分布以及术前化疗的施用有关。同时组进行了更多的微创和小切除术。存在医院差异（范围为 2.4% 至 83.3%），几家医院同时执行手术的频率比预期的高或低。同时切除导致 13% 的 30 天主要发病率和 1% 的死亡率。ASA 分级> 3 与同时切除后 30 天主要发病率较高独立相关（aOR 1.97，CI 1.10 – 3.42，p=0.018）。

讨论

独特的患者和肿瘤特征影响同时切除的选择。荷兰存在显着的医院差异。