Surgery for Colorectal Cancer Hepatic Metastases Has Little Effect on Health

Jane M. Blazeby, MD

Liver surgery for colorectal cancer (CRC) hepatic metastases has, for the most part, a minimal and brief negative impact on patient-reported outcomes (PROs), UK investigators reported.

However, the team, which analyzed responses to questionnaires completed by consecutive patients undergoing standard surgical resection of CRC liver metastases over a recent three-year period, also found an increase in complaints of sexual dysfunction and abdominal pain after surgery. The study was conducted at a single tertiary referral center.

Jane M. Blazeby, MD, professor of Surgery at the University of Bristol and University Hospitals Bristol National Health Services Foundation Trust, United Kingdom, and colleagues assessed PROs using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire—C30 (QLQ-C30) and Quality of Life Questionnaire—Liver Metastases C21 (QLQ-LMC21) before and 3, 6, and 12 months after surgery. The QLQ-C30 tests functional domains and symptoms that commonly occur in patients with cancer. The QLQ-LMC21 is specific for CRC hepatic metastases and includes four scales evaluating nutritional problems, activity/vigor problems, pain, and emotional function, and nine single-symptom items. Both questionnaires have been widely validated.

While hepatic resection of CRC is increasing, more information is needed about the impact of surgery on PROs, the authors said. Data from well-designed PRO studies are useful for evaluating treatment and guiding clinical decision making. Such information is especially important because it represents patients’ perspectives on treatment, which may differ from the views of health professionals.

Hepatic surgery was planned in 241 patients, but nine patients were eventually deemed ineligible because they were found to have unresectable metastatic disease.

There were 2 (0.9%) in-hospital deaths, and no patients required re-surgery. Fifty- eight (24.1%) patients developed complications, and 32 (15.9%) had recurrent disease at the end of the study period.

There was a 95% questionnaire compliance rate at all time points.

After surgery, most functional aspects of health deteriorated, and the percentages of patients describing severe symptoms increased. Also, 30% of patients cited severe problems with activity/vigor. However, the mean scores for functional scales returned to baseline levels at six months and were maintained at 12 months.

Most patients reported minimal or no symptoms at 12 months. However, 32.1% noted severe sexual dysfunction compared with only 21.6% at baseline. In addition, 11.9% of patients reported severe abdominal pain.

The authors pointed out that the strengths of the study included its prospective design, high questionnaire compliance rates, and the use of validated instruments.

Conversely, there was no control group, and the study was carried out at a single center. In addition, the study did not measure PROs during the period between discharge from the hospital and three months, which is a time interval that should be included in future studies of PROs, the authors said.

 

Rees JR, Blazeby JM, Fayers P, et al. Patient-reported outcomes after hepatic resection of colorectal cancer metastases [published online ahead of print March 19, 2012]. doi: 10.1200/JCO.2011.38.6177. J Clin Ocol. 2012;30(12):1364-1370.