Hospital variation and outcomes after repeat hepatic resection for colorectal liver metastases: a nationwide cohort study

Background Approximately 70% of patients with colorectal liver metastases (CRLM) experiences intrahepatic recurrence after initial liver resection. This study assessed outcomes and hospital variation in repeat liver resections. Methods This population-based study included all patients who underwent liver resection for CRLM between 2014 and 2022 in the Dutch Hepato Biliary Audit. Overall survival (OS) was collected for patients operated on between 2014 and 2018 by linkage to the insurance database. Results Data of 7479 liver resections (1391 (18.6%) repeat and 6088 (81.4%) primary) were analysed. Major morbidity and mortality were not different. Factors significantly associated with major morbidity included ASA 3+, major liver resection, extrahepatic disease, and open liver surgery. Five-year OS after repeat versus primary liver resection was 42.3% versus 44.8%, p = 0.37. Factors associated with worse OS included largest CRLM >5 cm (aHR 1.58, 95% CI: 1.07–2.34, p = 0.023), >3 CRLM (aHR 1.33, 95% CI: 1.00–1.75, p = 0.046), extrahepatic disease (aHR 1.60, 95% CI: 1.25–2.04, p = 0.001), positive tumour margins (aHR 1.42, 95% CI: 1.09–1.85, p = 0.009). Significant hospital variation in performance of repeat liver resection was observed, median 18.9%, ranging from 8.2% to 33.3%. Conclusion Significant hospital variation was observed in the performance of repeat liver resection in the Netherlands reflecting different treatment decisions upon recurrence. On a population-based level it leads to satisfactory survival.