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Related Experiment Video

Updated: Jun 23, 2026

Application of Laparoscopic Hepatectomy Combined with Intraoperative Microwave Ablation in Colorectal Cancer Liver Metastasis
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Application of Laparoscopic Hepatectomy Combined with Intraoperative Microwave Ablation in Colorectal Cancer Liver Metastasis

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Understanding Surgery Refusal in Patients with Colorectal Liver Metastases.

Laerke Wolf Andreasen1,2, Lucas Alexander Knøfler1,2, Delal Akdag1,2

  • 1Department of Digestive Diseases, Transplantation and General Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

Journal of Gastrointestinal Cancer
|June 22, 2026
PubMed
Summary

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Diagnostics (Basel, Switzerland)·2026

Surgery refusal for colorectal liver metastases (CRLM) is linked to lower BMI and longer time since diagnosis. Patients declining surgery face poorer survival outcomes, highlighting the need for better shared decision-making in CRLM treatment.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Colorectal liver metastases (CRLM) are a significant cause of cancer mortality.
  • Surgery offers the only curative option for CRLM, yet patient refusal occurs.
  • Factors influencing CRLM surgery refusal are not well understood.

Purpose of the Study:

  • To identify risk factors associated with CRLM surgery refusal.
  • To determine the reasons behind CRLM surgery refusal.
  • To analyze survival outcomes for CRLM patients who refuse surgery.

Main Methods:

  • Retrospective cohort study of resectable CRLM patients at Copenhagen University Hospital (2013-2023).
  • Matched 1:4 comparison of patients who refused versus accepted surgery based on WHO performance status.
Keywords:
CRLMLiver metastasesReasonsRefusalRisk factorsSurvival

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  • Conditional Logistic Regression for risk factors, frequency analysis for reasons, and Kaplan-Meier/Cox Regression for survival.

    • Main Results:

    • 1.4% (21/1478) of eligible CRLM patients refused surgery.
    • Lower BMI and longer time since primary diagnosis were significant risk factors for refusal.
    • Reasons included preference for chemotherapy, logistical issues, and perceived unfitness; refusal correlated with significantly worse survival.

    Conclusions:

    • This study is the first to detail risk factors and reasons for CRLM surgery refusal.
    • Findings offer insights for shared decision-making regarding CRLM treatment options.
    • Further research is recommended across various cancer types to enhance patient care strategies.