A population-based analysis on the rate and surgical management of colorectal liver metastases in Southern Germany

Purpose Early detection and multidisciplinary treatment of colorectal liver metastases (CLM), preferably resection, can significantly prolong the survival of colorectal cancer patients. The purpose of this study was to analyze the incidence, management and long-term clinical outcome of CLM patients using data from a regional German tumour registry. Methods We conducted a retrospective analysis of 884 patients diagnosed with colorectal adenocarcinoma in the year 2002 and documented in a regional tumor registry in Southern Germany. Results Two hundred thirty-six patients (26.7%) had or developed CLM, 132 patients (14.9%) had synchronous CLM and 104 patients (11.8%) developed metachronous CLM. At diagnosis of CLM, 86 patients (36.4%) had 3 or less documented lesions, 6 patients (2.5%) had 4 to 6 lesions and 89 patients (37.7%) showed multiple, diffuse metastases; for 55 patients (23.3%), the number of lesions was not specified. CLM patients (19.1%) (5.1% of all patients) underwent liver resection; a higher resection rate (28.3%) was observed in a subgroup of patients treated in two academic centres. Patients without CLM had a significantly better 5-year survival rate than patients with liver metastases (65.5% versus 16.3%). CLM patients with up to 3 liver metastases (i.e., potentially resectable) who underwent liver resection (n= 34) showed a significantly higher 5-year survival than non-resected patients (n= 52) (40% versus 5%). Conclusions The present study is the first population-based analysis of the surgical management and outcome of CLM in Southern Germany. The percentage of liver resections was lower than expected, particularly for patients with three or less metastases. The present data suggest that relevant undertreatment of CLM patients may occur which may have a negative impact on survival.