UPTAKE AND PATIENT OUTCOMES OF LAPAROSCOPIC LIVER RESECTION FOR COLON CANCER LIVER METASTASES. A POPULATION-BASED ANALYSIS.
Julian Wang*2, Christopher Griffiths2, Marko Simunovic1, Sameer Parpia3, Leyo Ruo1, Sean P. Cleary4, Pablo Serrano Aybar1
1Surgery, McMaster University, Hamilton, ON, Canada; 2Degroote School of Medicine, McMaster University, L8S4L8, ON, Canada; 3Oncology, McMaster University, Hamilton, ON, Canada; 4Surgery, Mayo Clinic, Rochester, MN
Background
The use of laparoscopic surgery for colorectal cancer liver metastases has not been well studied. We used population-based administrative data to measure the uptake and outcomes of laparoscopic liver surgery for colorectal cancer metastases in Ontario, Canada from 2006-2015.
Methods
We linked hospital administrative and vital statistic datasets. Three region-based hospital groups were categorized by their relative rate of laparoscopic liver surgery for all years of evaluated data (e.g., low-rate, medium-rate and high-rate). Outcomes compared among groups included rates of uptake of laparoscopic surgery, readmissions, major post-operative complications, and, median length of hospital stay (LOS). Overall survival was compared and estimated using Kaplan Meier with the log-rank test. Multivariable analysis clustered by hospital region were performed using logistic regression to determine risk factors associated with LOS and complications.
Results
Of the 2,995 liver resections performed on 2,675 patients, 443 (15%) were performed laparoscopically. This proportion varied significantly among the three groups (37/1,008 (4%) low-rate, 133/1075 (14%) medium-rate, and, 233/912 (28%) high-rate; P < 0.001). The rate of laparoscopic surgery increased by 1.1% per year (from 10% to 19%, p=0.02). There was no change over time in the low-rate group, whereas in the medium- and high-rate groups, it increased an average of 1.6% and 1.4% annually, respectively. On multivariable analysis, there was no difference on LOS or postoperative complications among our three groups, though laparoscopic resection was associated with a shorter LOS (regression coefficient -2.5 days, p<0.001) and lower postoperative complications (OR: 0.7, 95% CI: 0.6-0.9, p=0.04) even after adjusting for complexity of liver resection. With univariate analysis, median overall survival was significantly higher for the medium- (53 months, 95% CI: 48-62) and high-rate group (51 months, 95% CI: 45-59) compared to the low-rate group (46 months, 95% CI: 41 to 51, p=0.01).
Conclusion
The overall proportion of laparoscopic liver resection for colorectal cancer metastases in Ontario is low, and the uptake over time is increasing slowly among medium and high-rate hospital groups. The relative similar rates of laparoscopic surgery in our three hospital groups may explain why short-term outcomes were also similar among these groups.
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