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 ¹, Joost M Klaase ², Macel den Dulk ³

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

⁰Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands; Department of HPB Surgery and Liver Transplantation, University Medical Centre Groningen, Groningen, the Netherlands.

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology +

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October 1, 2025

View abstract on PubMed

Summary

Non-tumour factors like age, sex, and socioeconomic status influence colorectal liver metastases treatment. Healthcare systems must address access barriers for equitable care and improved outcomes.

Area Of Science

Oncology
Surgical Oncology
Health Services Research

Background

Synchronous colorectal liver metastases (CRLM) present complex treatment challenges.
Disparities in surgical treatment probability for CRLM patients are not well understood.
Non-tumour-related factors potentially impact treatment access and outcomes.

Purpose Of The Study

To evaluate disparities in surgical treatment for synchronous CRLM.
To identify non-tumour-related characteristics influencing CRLM treatment decisions.
To investigate factors affecting postoperative outcomes after CRLM resection.

Main Methods

Population-based study using Netherlands Cancer Registry (NCR) and Dutch Hepato Biliary Audit (DHBA) data (2015-2021).
Inclusion of patients diagnosed with synchronous CRLM.
Multivariable logistic regression models to assess associations between non-tumour factors, treatment likelihood, and outcomes.

Main Results

20% of 14,047 CRLM patients received local treatment.
Lower treatment likelihood associated with older age and female sex.
Higher socioeconomic status and presentation at a liver surgery center increased treatment likelihood.
Older age and high ASA-score were linked to increased morbidity and mortality.

Conclusions

Non-tumour factors (age, sex, SES, hospital) significantly influence CRLM treatment likelihood.
Not all identified factors impact postoperative outcomes.
Healthcare systems should address access barriers to ensure equitable CRLM treatment.

Keywords:

Local treatment Postoperative outcomes Selection Sex Socio-economic status Synchronous colorectal liver metastasis