While some surgical studies are now reporting five-year survival after surgery to remove colorectal cancer tumors that have spread to the liver of 40 to 60 percent, a review of more general national experience for patients enrolled in Medicare in the United States found lower survival rates.
Among Medicare-enrolled colorectal cancer patients 65 and over who had liver resection, only 26 percent (1 in 4) were alive five years later.
Analyzing 306,000 Medicare beneficiaries who were diagnosed with colon or rectal cancer in the years 2000 through 2004, researchers found 3,657 who had surgery to remove liver mets. Nearly 9 percent died within the first three months after surgery.
Those eighty and over were almost twice as likely to die within three months after surgery. Removing both the primary tumor in the colon or rectum and the liver tumors also raised the risk of death in those three months. Simultaneous resection of both colon and liver tumors increased three-month mortality two and a half times.
Survival at five years was 25.5 percent. Those at higher risk of not surviving were patients:
- aged 80 and older.
- with other medical conditions besides cancer.
- who had both colorectal and liver tumors removed at the same time (synchronous resection).
Douglas J. Robertson, MD, MPH and his colleagues at the Veterans Affairs Outcomes Research Group in Vermont and at Dartmouth Medical College concluded,
In this national study, short- and long-term survival was worse than that reported in surgical case series. Subgroups at high risk for worse outcomes include the extreme elderly and those undergoing synchronous colon and hepatic resection.
SOURCE: Robertson et al., Cancer, Volume 115, Issue 4, February 15, 2009.
What This Means for Patients
Survival rates after liver surgery for colorectal cancer mets differ between those large, specialized centers and the overall experience of Medicare patients nationally.
Some large studies reporting as many as half their patients living more than five years while nationally only 1 in 4 patients over 65 lives that long.
Finding a skilled and experienced surgeon and surgical team is important. Ask about the surgeon’s experience with removal of liver mets and survival rates in the hospital where the surgery is planned.
Simultaneous removal of both the colorectal primary tumor and liver mets may not be the best approach. Discuss the surgical plan carefully with your doctor.
A multidisciplinary team approach to planning treatment for advanced colorectal cancer is always best.