eP126 - Predictive Factors for Surgical Oncology Referrals in Colorectal Cancer Patients with Liver Metastases at a Single-Site Cancer Center

Purpose/Background: Colorectal cancer patients with liver metastases (CRLM) who undergo surgical resection of their liver show significantly improved 5-year survival (32.8%) compared to non-surgical cases (10.5%). Despite the curative potential of surgery, up to 63% of CRLM patients do not receive an initial evaluation by a surgical oncologist within standard clinical care. This study aims to identify factors influencing the referral of CRLM patients to surgical oncology within a single-site cancer center.Methods/Interventions: A retrospective chart review was conducted on Stage 4A CRLM patients treated at our center between 2010-2020. Patients who were not referred to surgical oncology at the time of diagnosis were identified and single-blind retrospective imaging review was then performed by a surgical oncologist to determine if any of these patients had been eligible for resection of their liver disease. These patients were then categorized into reasons why a referral was not made: a) referred for chemotherapy, b) hospice care, c) patient declined, d) lost to follow up, e) referred for chemoembolization. In addition, factors that could influence referral rates, such as demographics, disease comorbidities, metastases number and location, were analyzed. Comparisons between groups were conducted using the Mann-Whitney parametric test for continuous variables and Fisher exact test for categorical variables.Results/Outcomes: Out of 93 patients with Stage 4A CRLM disease treated between 2010 and 2020, 51 (54.8%) were never referred to surgical oncology. Retrospective imaging review identified 12 out of 51 (23.5%) patients as having had resectable liver disease. Of these 12 patients, 6 (50%) were referred for chemotherapy, 1 (8.3%) went to hospice, 2 (17%) declined, 2 (17%) were lost to follow up, and 1 (8.3%) was referred for chemoembolization. Older age (> 65 years) was the only significant (p < 0.005) factor between the patients with resectable disease who were referred versus those that were not referred to surgical oncology. An increased number of metastases sites (>5), multi-lobar liver disease, and comorbidities such as smoking, hypertension, coronary artery disease, and type 2 diabetes mellitus all showed no significant correlation (p < 0.05).Conclusion/

Discussion: These findings highlight a substantial gap in CRLM patient evaluation by surgical oncologists within standard clinical care. Given the improved survival outcomes seen in CRLM patients who undergo liver resection, further research is needed to identify reasons for this referral gap and develop strategies to address it. A more comprehensive consideration of the identified predictive factors from this study may enhance surgical resection referral rates for eligible patients.