[Liver metastases of colorectal carcinoma--may the DRG-system influence the operative procedure?]

Abstract

The economic analysis of surgery in colorectal liver metastases reveals the different effectiveness of various follow-up programmes after curative surgery for colorectal cancer. Interval hepatic resection for synchronous liver metastases is recommended in the majority of cases with rectal cancer. This procedure provides benefits for the patient and the hospital under the economic point of view. The interval between primary tumor resection and surgery of liver metastases does not deteriorate the prognosis, on the contrary, unnecessary resections will be avoided if additional metastases will grow in the time between, excluding curative treatment (selection mechanism). The identical statement cannot be applied to patients with colon cancer, since the operative risk is only slightly increased in case of easily accessible liver metastases which may be removed simultaneously. However, also in these patients interval hepatic resection after neoadjuvant chemotherapy should be considered as a therapeutic option! In patients with multiple liver metastases liver surgery as well as radiofrequency ablation or a combination of both may be economically justified. Radiofrequency ablation is the preferred palliative procedure under aspects of cost-effectiveness, however, wether this procedure is superior to chemotherapy alone has not be evaluated so far in prospectively randomized trials.