Shifting trends in liver-directed management of patients with colorectal liver metastasis: A population-based analysis

摘要: Background We sought to evaluate population-based temporal trends in perioperative management, as well short- and long-term outcomes associated with the operative management of colorectal liver metastasis (CRLM). Methods Using Surveillance, Epidemiology End Results–Medicare linked data, we identified 2,121 patients operatively managed CRLM between 1991 2006. Clinicopathologic survival were examined. Results Preoperative evaluation included computed tomography (CT; 66%), magnetic resonance imaging (MRI; 5%), positron emission (PET; 2%) a increase use all 3 modalities over time (all P n = 1,267; 60%) decreased time, whereas ablation alone ( 668; 32%) combined resection plus 186; 9%) increased comorbidities: 1991–1995, 3%; 2003–2006, 12%; > .05); 90-day mortality from 9% 7% study period .007). Overall 1-, 3-, 5-year survivals 74%, 42%, 28% no improvement .19). On multivariate analysis, synchronous disease (hazard ratio [HR], 1.7) (HR, 1.2) independently worse (both Conclusion Most evaluated CT; PET was employed rarely. Although there chemotherapy utilization, only one half received chemotherapy. Mortality hepatic operations low, but morbidity remained high change despite an number patient medical comorbidities.