HPB P13 Does Socioeconomic deprivation affect outcomes in patients undergoing liver resection for Colorectal Liver metastases?
Authors: Kaur Namratha , Scarpa Emanuele , Howard Joseph , Chin Carven , Hajibandeh Shahab , Alessandri Giorgio , Kumar Nagappan 
Published: December 2022

Abstract

Background
It is well documented that socioeconomic deprivation (SED) has an overall negative impact on health outcomes. Many studies have shown this in primary cancers. The effect of SED on outcomes in patients undergoing liver resection for colorectal liver metastases (CRLM) is not well documented. As these patients are already under follow up, it is likely that the impact of SED on outcomes will be diminished. It was our aim to evaluate the effect of SED on overall survival (OS) in patients undergoing liver resection for CRLM.

Methods
The STROCSS guideline for observational studies was followed to conduct a single-centre retrospective cohort study. The tertiary centre treats patients over a wide geographical area with a population of 2.2 million. All consecutive patients undergoing liver resection for CRLM between January 2013 and December 2020 were eligible for inclusion. Demographics, prognostic variables for CRLM, operative variables, pathological variables and overall survival was recorded. Data was censored at 31 December 2021. Follow up was complete and checked with the Clinical Portal electronic database and by contacting General practitioners. The Multiple Deprivation score, that is nationally recorded was used to determine socioeconomic deprivation status of each patient. Prognostic significance of socioeconomic deprivation was determined by Kaplan–Meier survival statistics and stepwise Cox proportional-hazards regression model.

Results
A total of 455 patients were eligible for inclusion; 237 patients were classed as least socioeconomically deprived and 218 patients as most socioeconomically deprived. Both cohorts were comparable in terms of baseline characteristics except for age (69 most deprived vs 72 Least deprived, P=0.004). Kaplan–Meier survival statistics showed that socioeconomic deprivation was associated with significantly lower probability of overall survival (HR: 1.55, 95% CI 1.23–1.95; Logrank test: P=0.0001). The stepwise Cox proportional-hazards regression analysis identified socioeconomic deprivation as predictor of OS (HR: 1.56, 95% CI 1.23–1.98, P=0.0003) alongside the following variables: ASA status 1 (HR: 0.43, 95% CI 0.19–0.94, P=0.0349), presence of extrahepatic disease (HR: 1.51, 95% CI 1.12–2.03, P=0.0075), number of tumours (HR: 1.07, 95% CI 1.01–1.13, P=0.0221), size of largest tumour (HR: 1.01, 95% CI 1.00–1.01, P=0.0003), extended hemihepatectomy (HR: 3.24, 95% CI 1.56–6.76, P=0.0018), and absence of recurrence (HR: 0.55, 95% CI 0.43–0.70, P&lt;0.0001).

Conclusions
Socioeconomic deprivation reduces the probability of OS following liver resection for CRLM. This should be taken into account at different levels of health care planning for management of patients with CRLM including preoperative risk assessment, health care need assessment, and allocation of resources. Our study shows that the deleterious effects of SED extends to patients who are already in the healthcare system and therefore factors other than access to healthcare need further exploration.