TY - JOUR
T1 - Population-based study on practice variation regarding preoperative systemic chemotherapy in patients with colorectal liver metastases and impact on short-term outcomes
AU - Elfrink, Arthur K. E.
AU - Kok, Niels F. M.
AU - van der Werf, Leonie R.
AU - Krul, Myrtle F.
AU - Marra, Elske
AU - Wouters, Michel W. J. M.
AU - Verhoef, Cornelis
AU - Kuhlmann, Koert F. D.
AU - den Dulk, Marcel
AU - Swijnenburg, Rutger-Jan
AU - te Riele, Wouter W.
AU - van den Boezem, Peter B.
AU - Leclercq, Wouter K. G.
AU - Lips, Daan J.
AU - Nieuwenhuijs, Vincent B.
AU - Gobardhan, Paul D.
AU - Hartgrink, Henk H.
AU - Buis, Carlijn I.
AU - Grünhagen, Dirk J.
AU - Klaase, Joost M.
AU - de Boer, Marieke T.
AU - Besselink, Marc G. H.
AU - Dejong, Cees H. C.
AU - van Gulik, Thomas H.
AU - Hagendoorn, Jeroen
AU - Hoogwater, Frederik J. H.
AU - Liem, Mike S. L.
AU - Molenaar, I. Quintus
AU - Patijn, Gijs A.
AU - Bosscha, Koop
AU - Belt, Eric J. Th
AU - Vermaas, Maarten
AU - Gerhards, Michael F.
AU - van Heek, N. T.
AU - Oosterling, Steven J.
AU - Torrenga, Hans
AU - Eker, Hasan H.
AU - Consten, Esther C. J.
AU - van Duijvendijk, Peter
AU - Dutch Hepato Biliary Audit Group
AU - Collaborators
AU - de Boer, Marieke T.
AU - Besselink, Marc G. H.
AU - Dejong, Cees H. C.
AU - van Gulik, Thomas H.
AU - Hagendoorn, Jeroen
AU - Hoogwater, Frederik J. H.
AU - Liem, Mike S. L.
AU - Molenaar, I. Quintus
AU - Patijn, Gijs A.
AU - Bosscha, Koop
AU - van Duijvendijk, Peter
N1 - Funding Information: The authors would like to thank all surgeons, interventional radiologists and administrative nurses for data registration in the DHBA database, as well as the Dutch Hepato Biliary Audit Group for scientific input. Publisher Copyright: © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/9
Y1 - 2020/9
N2 - 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), 30-day 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.
AB - 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), 30-day 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.
KW - Colorectal liver metastases
KW - Hospital variation
KW - Postoperative outcomes
KW - Preoperative chemotherapy
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85083324123&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejso.2020.03.221
DO - https://doi.org/10.1016/j.ejso.2020.03.221
M3 - Article
C2 - 32303416
SN - 0748-7983
VL - 46
SP - 1742
EP - 1755
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 9
ER -