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BACKGROUND.: Hepatectomy is the standard of care for patients withcolorectal cancer who have isolated hepatic metastases; however, thelong-term survival benefits of hepatectomy in this population have notbeen characterized well outside of case series. For the current study,a population-based database was used to compare the survival ofpatients with liver metastases from colorectal cancer who did and didnot undergo hepatectomy. METHODS.: Patients aged >/=65 years withincident colorectal cancer who were diagnosed from 1991 to 2001 wereidentified from the linked Surveillance, Epidemiology, and End Results(SEER)-Medicare database. Liver metastasis diagnoses, colorectalresections, and hepatectomies were identified from hospital,outpatient, and physician-supplier claims. Patients who did not undergocolorectal resection were excluded. Five-year survival from the time ofcancer diagnosis was determined by the Kaplan-Meier method. Coxproportional hazards models were used to evaluate survival. RESULTS.:Among 13,599 patients who were identified with incident colorectalcancer and liver metastases, 7673 patients (56.4%) presented with stageIV disease, and the remaining patients presented with earlier stagedisease and developed subsequent metastases. Only 833 patients (6.1%)in the cohort underwent hepatic resection, and their 30-day mortalityrate was 4.3%. The 5-year survival was 32.8% among patients whounderwent hepatic resection, compared with 10.5% among patients who didnot undergo hepatic resection (P < .0001), and better survival wasobserved in the subset of patients who presented initially with diseasein stages I through III. In a Cox model, which was controlled for age,sex, race, comorbidities, and stage at presentation, lack of hepaticresection was associated with a 2.78-fold increased risk of death.CONCLUSIONS.: Although hepatectomy rates among patients with colorectalcancer were low, hepatic resection was associated with improvedsurvival.
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