Hospital variation in combined liver resection and thermal ablation for colorectal liver metastases and impact on short-term postoperative outcomes: a nationwide population-based study

Arthur K.E. Elfrink*, Sanne Nieuwenhuizen, M. Petrousjka van den Tol, Mark C. Burgmans, Warner Prevoo, Marielle M.E. Coolsen, Peter B. van den Boezem, Otto M. van Delden, Jeroen Hagendoorn, Gijs A. Patijn, Wouter K.G. Leclercq, Mike S.L. Liem, Arjen M. Rijken, Cornelis Verhoef, Koert F.D. Kuhlmann, Simeon J.S. Ruiter, Dirk J. Grünhagen, Joost M. Klaase, Niels F.M. Kok, Martijn R. MeijerinkRutger Jan Swijnenburg, Wouter W. te Riele, Marieke T. de Boer, Cees H.C. Dejong, Thomas H. van Gulik, Frederik J.H. Hoogwater, I. Q. Molenaar, Christiaan van der Leij, Adriaan Moelker, Marc G.H. Besselink, Carlijn I. Buis, Marcel den Dulk, Koop Bosscha, Eric J.Th Belt, Maarten Vermaas, Tjarda N.T. van Heek, Steven J. Oosterling, Hans Torrenga, Hasan H. Eker, Esther C.J. Consten, Dutch Hepato Biliary Audit Group, Collaborators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Combining resection and thermal ablation can improve short-term postoperative outcomes in patients with colorectal liver metastases (CRLM). This study assessed nationwide hospital variation and short-term postoperative outcomes after combined resection and ablation. Methods: In this population-based study, all CRLM patients who underwent resection in the Netherlands between 2014 and 2018 were included. After propensity score matching for age, ASA-score, Charlson-score, diameter of largest CRLM, number of CRLM and earlier resection, postoperative outcomes were compared. Postoperative complicated course (PCC) was defined as discharge after 14 days or a major complication or death within 30 days of surgery. Results: Of 4639 included patients, 3697 (80%) underwent resection and 942 (20%) resection and ablation. Unadjusted percentage of patients who underwent resection and ablation per hospital ranged between 4 and 44%. Hospital variation persisted after case-mix correction. After matching, 734 patients remained in each group. Hospital stay (median 6 vs. 7 days, p = 0.011), PCC (11% vs. 14.7%, p = 0.043) and 30-day mortality (0.7% vs. 2.3%, p = 0.018) were lower in the resection and ablation group. Differences faded in multivariable logistic regression due to inclusion of major hepatectomy. Conclusion: Significant hospital variation was observed in the Netherlands. Short-term postoperative outcomes were better after combined resection and ablation, attributed to avoiding complications associated with major hepatectomy.

Original languageEnglish
JournalHPB
DOIs
Publication statusAccepted/In press - 2020

Cite this