Outcomes after detection of metastatic carcinoma of the colon and rectum in a national hospital system

Abstract

Background: Selected institutions have reported good results with resection for metastatic carcinoma of the colon and rectum, but the number of patients and the expenses required to identify the resectable metastases are unknown.

Study design: A retrospective survival analysis was performed using computerized files of the United States Department of Veterans Affairs hospitals from 1988 to 1992, complete through December 1994. Survival was calculated from diagnosis or resection until death. Patients without a death record were assumed to be alive.

Results: In all, 22,715 patients underwent colectomy for carcinoma, and 12,150 presented with metastatic carcinoma of the colon and rectum, of which 6,607 had hepatic and 2,659 had pulmonary metastases. Only 2,040 patients with hepatic (and 514 with pulmonary metastases had no prior or other metastatic sites. Of the patients with hepatic metastases, 887 had a computed tomography (CT) scan or liver biopsy, or both, for diagnosis; 133 hepatic and 76 pulmonary resections were done. The projected five-year survival rate after hepatic resection was 26 percent, mean survival was 31 months, and the 30-day mortality rate was 4 percent. After pulmonary resection, results were similar: 36 percent, 38 months, and 3 percent, respectively. The 887 patients with hepatic metastases documented by CT scan or biopsy results has a mean survival of 11 months, and less than 2 percent were alive or unavailable for follow-up examination at analysis. Estimated surveillance costs alone averaged $1.3 million per life saved by resection, or $203,000 per year of added life.

Conclusions: Resection of isolated colorectal metastases produced 70 five-year survivors (hepatic, n=42, pulmonary, n=28) and accounted for 446 additional years of patient life over that expected without resection.