The timing of liver resection in patients with colorectal cancer and synchronous liver metastases: a population-based study of current practice and survival

There is uncertainty regarding the optimal sequence of surgery for patients with colorectal cancer (CRC) and synchronous liver metastases. This study was designed to describe temporal trends and inter-hospital variation in surgical strategy, and to compare long-term survival in a propensity score-matched analysis.The National Bowel Cancer Audit dataset was used to identify patients diagnosed with primary CRC between 1st January 2010 and 31st December 2015 who underwent CRC resection in the English National Health Service. Hospital Episode Statistics data was used to identify those with synchronous liver-limited metastases who underwent liver resection. Survival outcomes of propensity score-matched groups were compared.Of 1830 patients, 270 (14.8%) patients underwent a liver-first approach, 259 (14.2%) a simultaneous approach and 1301 (71.1%) a bowel-first approach. The proportion of patients undergoing either a liver-first or simultaneous approach increased over the study period, from 26.8% in 2010 to 35.6% in 2015 (P<0.001). There was wide variation in surgical approach according to hospital trust of diagnosis. There was no evidence of a difference in four-year survival between the propensity score-matched cohorts according to surgical strategy: bowel-first vs. simultaneous (HR 0.92 (95% CI 0.80-1.06)) or bowel-first vs. liver-first ((HR 0.99 (95% CI 0.82-1.19)).There is evidence of wide variation in surgical strategy in dealing with CRC and synchronous liver metastases. In selected patients, the simultaneous and liver-first strategies have comparable long-term survival to the bowel-first approach. This article is protected by copyright. All rights reserved.