Association between race, hospital volume of major liver surgery and access to metastasectomy for colorectal liver metastases

Presenter: Annabelle Jones MD | Brigham and Women's Hospital Background: In select patients with colorectal cancer liver metastases (CRLM), metastasectomy curative-intent has been found to be associated a 5-year overall survival that is greater than 50%. Despite recent advancements, it estimated only half of potentially resectable CRLM are undergoing metastasectomy. Previous studies have demonstrated non-White were significantly less likely undergo as compared White patients. Additionally, hospital variation in access volume surgery medical care for the primary site. The aim this study evaluate differences according hospital-year (HVLS). We hypothesized would HVLS, racial lower hospitals highest HVLS. Methods: National Cancer Database (NCDB) Colon, Rectosigmoid Junction Rectum data (2011-2017) used identify confirmed histology adenocarcinoma who underwent site surgical resection had without evidence extra-hepatic disease. Using 2011-2017 Liver NCDB, stratified into quartiles HVLS included formal extended hepatectomy transplants. A Poisson regression model adjusted age, gender, Charlson-Deyo score, insurance type, facility income quartiles, treatment at multiple facilities, margin, nodal, systemic therapy status was interaction between race (lowest highest) Results: identified 27,342 (median age 60, IQR 51-70, 55.6% male, 82.9% White, 17.2% non-White) CRLM. majority did not (n = 20,714, 76%). Of 6,628 treated metastasectomy, 45.4% 3,009) perform any major surgery. Overall, after adjusting potential confounders (RR 0.88, 95% CI 0.82-0.95, p 0.001). Additional patient factors likelihood Medicaid insurance, being uninsured, positive margin cancer. Among quartile hospitals, 0.84, 0.73-0.97, 0.017, Table). lowest (Table). Conclusion: Undergoing where received their care. Although translate equal Racial disparities persist CRLM, future research needed develop innovative strategies address disparity accessing