Discrepancies between medical oncologists and surgeons in assessment of resectability and indication for chemotherapy in patients with colorectal liver metastases

Homayounfar, Kia; Bleckmann, Annalen; Helms, Hans‐Joachim; Lordick, Florian; Rüschoff, Josef; Conradi, Lena‐Christin; Sprenger, Thilo; Ghadimi, Michael; Liersch, Torsten

doi:10.1002/bjs.9436

Cited by 44 publications

(38 citation statements)

References 32 publications

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“…Especially the expertise of colorectal, hepatobiliary, thoracic, and peritoneal surface surgeons next to medical and radiation oncologists, interventional radiologists, gastroenterologists, and pathologists should be available within the MDT . It has been shown that training sessions have a positive impact on the performance of MDTs with more metastatic patients deemed resectable . Our results confirm the quality of pathways pursued within the MDT due to the high rate of complete resections and the survival rate of more than 50%.…”

Section: Discussionsupporting

confidence: 75%

Prognosis in patients with synchronous colorectal cancer metastases after complete resection of the primary tumor and the metastases

Radulova-Mauersberger

Zschuppe

Kittner

et al. 2019

Journal of Surgical Oncology

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Background Synchronous metastases are considered a negative prognostic factor in patients with metastatic colorectal cancer (CRC). We investigated the outcomes of stage IV CRC patients undergoing complete gross resection (R0/1) of both the primary tumor and the metastases under the guidance of a multidisciplinary team (MDT). Methods All CRC patients with synchronous metastases were retrieved from a prospective database. Patients treated from 2006 to 2017 who underwent complete resection were analyzed. Various factors, including multiple metastatic sites and complex procedures, were investigated. Univariate and multivariate overall survival (OS) calculations were performed. Results Of 330 consecutive patients with synchronous metastases, 101 (30.6%) achieved an R0/1 status including 12 (11.9%) patients with multiple metastatic sites. Complex procedures were necessary in 45 (44.6%) patients. Five‐year OS was 53.0% for the R0/1 patient group. Multivariate analysis could not detect factors associated with prognosis. Conclusions With modern treatment, the prognosis of patients with synchronous CRC metastases can be improved. Decisions made by a MDT offered one‐third of patients a potentially curative approach to their stage IV disease. Despite the treatment of a high rate of patients with complex metastases necessitating complex procedures, we achieved a favorable 5‐year OS rate.

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Section: Discussionsupporting

confidence: 75%

Prognosis in patients with synchronous colorectal cancer metastases after complete resection of the primary tumor and the metastases

Radulova-Mauersberger

Zschuppe

Kittner

et al. 2019

Journal of Surgical Oncology

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“…In a virtual board meeting with 30 cases presented to 11 surgeons and 10 medical oncologists, surgeons considered CRLMs resectable more often than did medical oncologists. 6 Medical oncologists were more likely than surgeons to indicate preoperative chemotherapy, mostly in cases deemed unresectable. Interestingly, the proportion of cases considered unresectable and the indication for preoperative chemotherapy by both surgeons and medical oncologists decreased after an educational intervention outlining the latest resectability criteria.…”

Section: Discussionmentioning

confidence: 99%

“…5 Perhaps even more important, wide variability in definitions of resectable disease and referral patterns for patients with CRLMs have also been reported. [6][7][8] This study serves as a pilot to investigate an initial resectability assessment and specialty referral of patients with CRLMs across multiple oncologic specialties and subspecialties (general surgeons, colorectal surgeons, surgical oncologists and medical oncologists) compared to a panel of hepatobiliary surgeons.…”

Section: Résultatsmentioning

confidence: 99%

Assessing resectability of colorectal liver metastases: How do different subspecialties interpret the same data?

Aubin

Bressan

Grondin

et al. 2018

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“…When patients are diagnosed in these hospitals they are discussed in multidisciplinary teams, where a specialist liver surgeons is not always involved in these meetings. Also the presence of a dedicated medical oncologist is demonstrated to be important in considering patients suitable for neo-adjuvant chemotherapy in patients with CRLM [37]. Jones et al [38] demonstrated that even in high-volume centers (UK cancer network), almost two-thirds of patients with tumors who were deemed unresectable by non-liver surgeons were considered potentially resectable by a panel of specialist liver surgeons.…”

Section: Discussionmentioning

confidence: 99%

Liver Resection for Metastatic Disease; A Population-Based Analysis of Trends

Ridder

Lemmens²,

Overbeek³

et al. 2016

Dig Surg

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Objective: The study aims to evaluate all patients who underwent liver resection for metastatic disease for demographics, characteristics of the primary tumor and metastasis, volume of liver resection specimens per pathology laboratory and to describe trends in surgical treatment. Methods: Data were prospectively collected using the Dutch nationwide pathology network. All pathology reports containing details on liver resections for metastatic disease between January 2001 and December 2010 were evaluated. Results: A total of 3,916 liver resections were performed in 3,699 patients with a median age of 63 years (range 1-91). The primary tumor was mainly colorectal (n = 3,256; 88.0%). The number of ‘high volume liver centers' increased from 2 to 12 in the study period, whereas the number of ‘low volume centers' decreased. The number of liver resections increased from 224 to 596 per year (p ≤ 0.0001). A significant increase was demonstrated in elderly patients, patients with multiple metastases, liver resections for smaller metastases and minor liver resections. Conclusion: Although the majority of patients were young and had solitary metastasis, indications for liver resection are expanding as indicated by increasing numbers of elderly and patients with multiple liver metastases. Patients with non-colorectal liver metastases were seldom candidates for resection.

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Discrepancies between medical oncologists and surgeons in assessment of resectability and indication for chemotherapy in patients with colorectal liver metastases

Abstract: Resectability and indication for preoperative chemotherapy were assessed differently by medical oncologists and surgeons. The educational intervention resulted in more patients deemed resectable by both oncologists and surgeons, and less frequent indication for chemotherapy.

Cited by 44 publications

References 32 publications

Prognosis in patients with synchronous colorectal cancer metastases after complete resection of the primary tumor and the metastases

Prognosis in patients with synchronous colorectal cancer metastases after complete resection of the primary tumor and the metastases

Assessing resectability of colorectal liver metastases: How do different subspecialties interpret the same data?

Liver Resection for Metastatic Disease; A Population-Based Analysis of Trends

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