Selection for local treatment and outcomes of surgical resection in patients with synchronous colorectal liver metastases: A nationwide population-based study

Michelle R de Graaff; Joost M Klaase; Macel den Dulk; Dirk J Grünhagen; R-J Swijnenburg; G Kazemier; M Liem; E J T Belt; M Vermaas; J S D Mieog; P Gobardhan; A Rijken; S J Oosterling; K Bosscha; Niels F M Kok; MarloesA G Elferink; Dutch Hepato Biliary Audit Group (DHBA) and National Cancer Registry (NCR)

doi:10.1016/j.ejso.2025.110411

Selection for local treatment and outcomes of surgical resection in patients with synchronous colorectal liver metastases: A nationwide population-based study

Eur J Surg Oncol. 2025 Nov;51(11):110411. doi: 10.1016/j.ejso.2025.110411. Epub 2025 Aug 28.

Authors

Michelle R de Graaff¹, Joost M Klaase², Macel den Dulk³, Dirk J Grünhagen⁴, R-J Swijnenburg⁵, G Kazemier⁵, M Liem⁶, E J T Belt⁷, M Vermaas⁸, J S D Mieog⁹, P Gobardhan¹⁰, A Rijken¹⁰, S J Oosterling¹¹, K Bosscha¹², Niels F M Kok¹³, MarloesA G Elferink¹⁴; Dutch Hepato Biliary Audit Group (DHBA) and National Cancer Registry (NCR)

Collaborators

Dutch Hepato Biliary Audit Group (DHBA) and National Cancer Registry (NCR):
Hans Torrenga, N Tjarda van Heek, C I Buis, Wouter Derksen, Jeroen Hagendoorn, Wouter K G Leclercq, Koert Kuhlmann, Peter van den Boezem, Eric R Manusama, Peter van Duijvendijk, Gijs Patijn

Affiliations

¹ Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of HPB Surgery and Liver Transplantation, University Medical Centre Groningen, Groningen, the Netherlands.
² Department of HPB Surgery and Liver Transplantation, University Medical Centre Groningen, Groningen, the Netherlands.
³ Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; NUTRIM-School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
⁴ Department of Surgery, Erasmus MC, Rotterdam, the Netherlands.
⁵ Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁶ Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands.
⁷ Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
⁸ Department of Surgery, Ijsselland Hospital, Capelle aan de Ijssel, the Netherlands.
⁹ Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
¹⁰ Department of Surgery, Amphia Medical Centre, Breda, the Netherlands.
¹¹ Department of Surgery, Spaarne Gasthuis, Haarlem, the Netherlands.
¹² Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands.
¹³ Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands. Electronic address: n.kok@nki.nl.
¹⁴ Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands.

PMID: 41033233
DOI: 10.1016/j.ejso.2025.110411

Abstract

Background: The aim of this study was to evaluate potential disparities in the probability of undergoing surgical treatment among patients with synchronous colorectal liver metastases (CRLM) and to investigate which non-tumour-related characteristics influenced postoperative outcomes.

Methods: This was a population-based study of all patients diagnosed with synchronous CRLM between 2015 and 2021 in the Netherlands. Data were retrieved from the Netherlands Cancer Registry (NCR) and data of patients who underwent surgical exploration were retrieved from the Dutch Hepato Biliary Audit (DHBA). The association between non-tumour-related factors, the chance of getting local treatment of CRLM and outcomes after resection were evaluated using multivariable logistic regression models.

Results: From the NCR, 14,047 patients with synchronous CRLM were included. Of these 2753 (20 %) patients underwent local treatment of CRLM. Non-tumour-related factors associated with a lower likelihood of local treatment of CRLM included age (OR 0.94 95 %CI 0.94-0.95) and female sex (OR 0.87, 95 %CI 0.78-0.97). Middle and high Socioeconomic status (SES) compared to low SES (respectively OR 1.35, 95 %CI 1.18-1.54 and OR 1.61, 95 %CI 1.41-1.84) and presentation in a hospital that performed liver surgery (OR 1.52, 95 %CI 1.26-1.84) were associated with a higher likelihood of getting local treatment. From the DHBA 2535 patients were included. Non-tumour-related factors associated with both major morbidity and mortality included age (OR 1.01 95 %CI 1.00-1.03 and OR 1.07, 95 %CI 1.02-1.11, respectively) and ASA-score ≥3 (OR 1.7,95 %CI 1.34-2.29 and OR 2.88, 95 CI 1.92-1.11) respectively.

Conclusion: In addition to tumour-related factors, non-tumour-related factors, including age, male sex, SES and hospital of presentation, all contributed to the likelihood of getting local treatment for CRLM. As not all these factors influence postoperative outcomes, healthcare systems should also focus on eliminating barriers to accessing appropriate care.

Keywords: Local treatment; Postoperative outcomes; Selection; Sex; Socio-economic status; Synchronous colorectal liver metastasis.

MeSH terms

Adult
Age Factors
Aged
Aged, 80 and over
Colorectal Neoplasms* / pathology
Female
Hepatectomy*
Humans
Liver Neoplasms* / secondary
Liver Neoplasms* / surgery
Male
Middle Aged
Netherlands / epidemiology
Patient Selection*
Registries
Sex Factors
Social Class
Treatment Outcome