Table IV.
Preoperative staging, operative details, and postoperative outcomes of operatively managed patients with CRLM, SEER–Medicare, 1991–2006
| Total | 1991–1995 | 1996–2000 | 2001–2002 | 2003–2006 | |
|---|---|---|---|---|---|
| n | 2,121 | 468 | 574 | 404 | 675 |
| Preoperative staging within 6 months | |||||
| MRI abdomen* | 107 (5.0) | 11 (2.4) | 22 (3.8) | 25 (6.2) | 49 (7.3) |
| CT abdomen* | 1,398 (65.9) | 247 (52.8) | 330 (57.5) | 296 (73.3) | 525 (77.8) |
| PET* | 40 (1.9) | 0 (0.0) | <11 (<1.9) | <11 (<2.7) | 37 (5.5) |
| Diagnostic laparoscopy* | 54 (2.5) | <11 (<2.4) | <11 (<1.9) | 13 (3.2) | 24 (3.6) |
| Portal vein embolization | <11 (<0.5) | <11 (<2.4) | <11 (<1.9) | <11 (<2.7) | <11 (<1.6) |
| Hepatic resection | |||||
| Hepatectomy alone* | 1,267 (59.7) | 333 (71.2) | 359 (62.5) | 224 (55.4) | 351 (52.0) |
| Partial hepatectomy* | 1,199 (56.5) | 307 (65.6) | 325 (56.6) | 212 (52.5) | 355 (52.6) |
| Hemihepatectomy | 422 (19.9) | 90 (19.2) | 116 (20.2) | 79 (19.6) | 137 (20.3) |
| Extended hepatectomy | 43 (2.0) | 13 (2.8) | 11 (1.9) | <11 (<2.7) | <11 (<1.6) |
| Hepatectomy and ablation* | 186 (8.8) | 29 (6.2) | 38 (6.6) | 36 (8.9) | 83 (12.3) |
| Ablation alone* | 668 (31.5) | 106 (22.6) | 177 (30.8) | 144 (35.6) | 241 (35.7) |
| Systemic therapy | |||||
| Preoperative chemotherapy* | 275 (13.0) | 45 (9.6) | 63 (11.0) | 59 (14.6) | 108 (16.0) |
| Adjuvant chemotherapy*,† | 868 (40.9) | 162 (34.6) | 223 (38.9) | 167 (41.3) | 316 (46.8) |
| Both preoperative and adjuvant chemotherapy* | 151 (7.1) | 26 (5.6) | 29 (5.1) | 31 (7.7) | 65 (9.6) |
| TACE | 13 (0.6) | <11 (<2.4) | <11 (<1.9) | <11 (<2.7) | <11 (<1.6) |
| Morbidity | |||||
| Any | 1,334 (62.9) | 298 (63.7) | 367 (63.9) | 252 (62.4) | 417 (61.8) |
| Reexploration after operation* | 95 (4.5) | 28 (6.0) | 30 (5.2) | 22 (5.4) | 15 (2.2) |
| Postoperative hemorrhage* | 95 (4.5) | 33 (7.1) | 27 (4.7) | 15 (3.7) | 20 (3.0) |
| Postoperative infection | 146 (6.9) | 30 (6.4) | 35 (6.1) | 25 (6.2) | 56 (8.3) |
| Percutaneous drain* | 307 (14.5) | 46 (9.8) | 65 (11.3) | 70 (17.3) | 126 (18.7) |
| Survival from liver-directed therapy | |||||
| Median (mos) | 28.0 | 28.0 | 28.0 | 27.0 | NR |
| 3-Year (%) | 41.9 | 41.7 | 40.6 | 41.2 | 51.7 |
| 30-Day mortality‡ | 59 (2.8) | <11 (<2.4) | 21 (3.7) | <11 (<2.7) | 16 (2.4) |
| 90-Day mortality§ | 210 (9.9) | 43 (9.2) | 73 (12.7) | 46 (11.4) | 48 (7.1) |
*
Significant at P < .05 by linear-by-linear association test of trend.
†
Postoperative chemotherapy given within 3 months after liver-directed therapy.
‡
Death within 30 days of liver-directed therapy.
§
Death within 90 days of liver-directed therapy.
Data are presented as number of patients (%).
NR, Not reached; TACE, transcatheter arterial chemoembolization.