Introduction Half of all patients with colorectal cancer (CRC) develop liver metastases (LM). Liver resection offers the greatest survival benefit in suitable patients with 5- and 10-year survival rates of 30%–58% and 25% respectively. There remains great variability in access to liver resection in the UK. We sought to investigate this within a cancer network known to already have a high rate of resection of CRCLM.
Methods A prospective study of all patients presenting with new CRCLM in a cancer network was undertaken over a 12-month period. A study proforma was approved by the network to assess management decisions for all patients with CRCLM discussed at the seven CRC multidisciplinary team (MDT) meetings. Data were retrospectively collected on patients with CRCLM who did not have the proforma completed. Outcomes for all patients referred to the tertiary liver MDT were recorded and collated. Subsequently radiology of patients deemed inoperable at the CRC MDTs was reviewed by the liver MDT.
Results In total 631 patients with new CRCLM were assessed at CRC MDT meetings. Study forms were completed for 241 (38%). 66% had synchronous disease and 42% unilobar disease. In all, 27% of patients were referred to the liver MDT for consideration of resection while 17% were deemed unfit, 2% refused referral, 17% gave no reason and 64% were thought inoperable. In the liver MDT, 142 new patients were discussed from this network. 74% of patients reviewed were deemed suitable for further curative treatment; 52% resected and 22% neoadjuvant chemotherapy with a view to resection with a further 1% receiving ablation. Radiology for the patients considered fit but inoperable at CRC MDTs was retrospectively reviewed by a hepatobiliary radiologist and Liver surgeon and demonstrated a further 29% of patients were deemed operable and 15% of patients had equivocal imaging and warranted further investigation. Applied across the cancer network, this suggests that if all suitable patients were referred to the liver MDT, referral rates would increase by 142%.
Conclusion Despite increased resection rates for CRCLM in the last decade, this prospective study shows a significant number of patients with potentially resectable disease are still not assessed in a specialist MDT. Improved referral rates may improve resection rates and improve overall outcomes for CRC patients. Extrapolation of these figures across the UK suggests improvements in referral practice of patients with CRCLM without any change in resection practice or post-resection outcomes could increase the number of patients with CRC in the UK alive at 5 years by 5%.
Competing interests None declared.