EP639 - The Association of Hospital Volume of Colorectal Liver Metastasis Resection and Mortality: A National Cancer Database Analysis

Monday, May 12, 2025

8:43 AM – 8:48 AM PT

Location: Monitor 5, Sails Pavilion, Upper Level

ePoster Presenter(s)

SK

Saher-Zahra Khan, MD

General Surgery Resident
University Hospitals Cleveland Medical Center
South Euclid, Ohio, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

AL

Alexander Loftus, MD

General Surgery Resident
University Hospitals Cleveland Medical Center
Cleveland, Ohio, United States

Disclosure information not submitted.
NC

Natalie N. Chakraborty, MD

General Surgery Resident
University Hospitals Cleveland Medical Center
Cleveland, Ohio, United States

Disclosure information not submitted.
ES

Emily F. Simon, MD (she/her/hers)

General Surgery Resident
University Hospitals Cleveland Medical Center, Department of Surgery
Cleveland, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
JS

Jennifer Selfridge, MD, PhD

Assistant Professor
University Hospitals Cleveland Medical Center
Cleveland, Ohio, United States

Disclosure information not submitted.
Ronald Charles, MD (he/him/his)

Assistant Professor of Surgery
University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
Cleveland, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
JA

John Ammori, MD

Professor of Surgery
University Hospitals Cleveland Medical Center
Cleveland, Ohio, United States

Disclosure information not submitted.
ES

Emily Steinhagen, MD, FACS, FASCRS

Associate Professor of Surgery
University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
Cleveland, Ohio, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Saher-Zahra Khan, MD: This individual has no financial relationships with ineligible companies.

Emily F. Simon, MD: This individual has no financial relationships with ineligible companies.

Ronald Charles, MD: This individual has no financial relationships with ineligible companies.

Emily Steinhagen, MD, FACS, FASCRS: This individual has no financial relationships with ineligible companies.

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Purpose/Background: Colorectal cancer liver metastases occur in up to 25% of patients. Surgical treatment of resectable lesions is recommended. Low surgical volume has been associated with increased mortality and poor oncologic outcomes for colorectal surgery and liver resections separately, but the impact of hospital volume of colorectal liver metastasectomy (CRLM) has not been described. The aim of this study was to assess the relationship between CRLM volume, mortality, and social determinants of health. We further aimed to determine factors associated with receipt of CRLM.

Methods/Interventions: The National Cancer Database (NCDB) 2004-2020 was used to identify patients with Stage IV colon, rectosigmoid, and rectal adenocarcinoma with isolated liver metastases. We excluded patients that did not undergo surgical resection of the primary site, patients treated at multiple facilities, and patients with other metastatic sites. Logistic regression was performed to assess demographic factors predictive of undergoing metastasectomy. Ten-year volume of CRLM at each facility was stratified into tertiles of low-volume centers (1-7), medium-volume centers (8-16), and high-volume centers (17+). Multivariate Cox regression was performed to assess survival using surgical volume and patient demographic factors. Subset analysis was performed within high-volume centers. Odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI) are presented.

Results/Outcomes: A total of 25,551 patients with isolated liver metastases were identified, of whom 7,158 (28%) underwent liver metastasectomy. Factors associated with receipt of liver resection included younger age, female sex (OR 1.13), treatment at Academic facility (OR 2.21) or Integrated Network Cancer facility (OR 1.40), and presence of private insurance (OR 1.57), Medicare (OR 1.41), and Medicaid (OR 1.33). CRLM at a high-volume (HR 0.80) center was associated with lower mortality. Age over 60, Non-Hispanic Black race, and increased Charlson-Deyo Score (CDS) were associated with higher mortality, whereas Hispanic ethnicity and treatment at an Academic facility were associated with lower mortality. When limited to high-volume centers, age over 70 and CDS of 1 or 3 were associated with higher mortality, whereas CRLM at an Academic or Integrated Network Cancer facility was associated with lower mortality. Race was no longer associated with mortality at high volume centers.

Conclusion/Discussion: CRLM at high-volume centers was associated with lower mortality. Non-Hispanic Black race was associated with poorer outcomes after CRLM, but this disparity did not exist when the analysis was restricted to only high-volume hospitals. Referral of patients to specialized high-volume centers for CRLM may improve outcomes and reduce disparities related to race.