Beyond Survival: Prospective Longitudinal Insights into Health-related Quality of Life After Hepatectomy for High-risk Colorectal Liver Metastases.

OBJECTIVE: Describe the long-term health-related quality of life (HR-QoL) after curative-intent hepatectomy for high-risk colorectal liver metastases (CRLM). METHODS: This prospective study enrolled patients with resectable CRLM with clinical risk score ≥3. European Organization for Research and Treatment of Cancer QLQ-C30, LMC21, and EuroQol EQ-5D-5L were administered at preoperative and postoperative visits, and at 6, 12, 18, 24, and 36 months from hepatectomy, and cancer disease state was recorded. Linear mixed models were used to examine the trajectory of HR-QoL scores. RESULTS: From 297 consented, 146 were evaluable by completing preoperative and postoperative surveys. Median age was 52 years, 42% (n=61) were female, and 70% (n=102) had synchronous CRLM. The QLQ-C30 summary score decreased by -14.6 points (95% CI: -17.2, -12.0) from baseline at the postoperative survey (P<0.001) with return to preoperative levels at 12 months. Self-assessed health state on EQ-VAS decreased postoperatively by -8.9 points (95% CI: -12.2, -5.5) (P<0.001) with recovery to baseline by 6 months. Among patients with no evidence of disease (NED), QLQ-C30 summary scores recovered to preoperative levels 6 months after hepatectomy, whereas those with recurrent cancer reported scores below baseline at every follow-up assessment (all P<0.05). On EQ-VAS, NED patients were comparable to baseline at 6 months and reported higher scores than baseline at 24 months (P=0.029). Patients with recurrence had similar EQ-VAS scores as baseline at 12 months but remained lower than NED patients at each timepoint after the postoperative survey (all P<0.05). CONCLUSIONS: HR-QoL decreases postoperatively before returning to preoperative levels and exceeding it among patients without recurrence. Cancer recurrence significantly influenced HR-QoL.