BACKGROUND: Multimodal treatment of colorectal liver metastases (CRLMs) relies on precise upfront assessment of resectability. Variability in the definition of resectable disease and the importance of early consultation by a liver surgeon have been reported. In this pilot study we investigated the initial resectability assessment and patterns of referral of patients with CRLMs. METHODS: Surgeons and medical oncologists involved in the management of colorectal cancer at 2 academic institutions and affiliated community hospitals were surveyed. Opinions were sought regarding resectability of CRLMs and the type of initial specialty referral (hepatobiliary surgery, medical oncology, palliative care or other) in 6 clinical cases derived from actual cases of successfully performed 1- or 2-stage resection/ablation of hepatic disease. Case scenarios were selected to illustrate critical aspects of assessment of resectability, best therapeutic approaches and specialty referral. Standard statistical analyses were performed. RESULTS: Of the 75 surgeons contacted, 64 responded (response rate 85%; 372 resectability assessments completed). Hepatic metastases were more often considered resectable by hepatobiliary surgeons than all other respondents (92% v. 57%, p < 0.001). Upfront systemic therapy was most commonly prioritized by surgical oncologists (p = 0.01). Hepatobiliary referral was still considered in 73% of "unresectable" assessments by colorectal surgeons, 59% of those by general surgeons, 57% of those by medical oncologists and 33% of those by surgical oncologists (p = 0.1). CONCLUSION: Assessment of resectability varied significantly between specialties, and resectability was often underestimated by nonhepatobiliary surgeons. Hepatobiliary referral was not considered in a substantial proportion of cases erroneously deemed unresectable. These disparities result largely from an imprecise understanding of modern surgical indications for resection of CRLMs.
BACKGROUND: Multimodal treatment of colorectal liver metastases (CRLMs) relies on precise upfront assessment of resectability. Variability in the definition of resectable disease and the importance of early consultation by a liver surgeon have been reported. In this pilot study we investigated the initial resectability assessment and patterns of referral of patients with CRLMs. METHODS: Surgeons and medical oncologists involved in the management of colorectal cancer at 2 academic institutions and affiliated community hospitals were surveyed. Opinions were sought regarding resectability of CRLMs and the type of initial specialty referral (hepatobiliary surgery, medical oncology, palliative care or other) in 6 clinical cases derived from actual cases of successfully performed 1- or 2-stage resection/ablation of hepatic disease. Case scenarios were selected to illustrate critical aspects of assessment of resectability, best therapeutic approaches and specialty referral. Standard statistical analyses were performed. RESULTS: Of the 75 surgeons contacted, 64 responded (response rate 85%; 372 resectability assessments completed). Hepatic metastases were more often considered resectable by hepatobiliary surgeons than all other respondents (92% v. 57%, p < 0.001). Upfront systemic therapy was most commonly prioritized by surgical oncologists (p = 0.01). Hepatobiliary referral was still considered in 73% of "unresectable" assessments by colorectal surgeons, 59% of those by general surgeons, 57% of those by medical oncologists and 33% of those by surgical oncologists (p = 0.1). CONCLUSION: Assessment of resectability varied significantly between specialties, and resectability was often underestimated by nonhepatobiliary surgeons. Hepatobiliary referral was not considered in a substantial proportion of cases erroneously deemed unresectable. These disparities result largely from an imprecise understanding of modern surgical indications for resection of CRLMs.
Authors: Chusilp Charnsangavej; Bryan Clary; Yuman Fong; Axel Grothey; Timothy M Pawlik; Michael A Choti Journal: Ann Surg Oncol Date: 2006-09-01 Impact factor: 5.344
Authors: Hari Nathan; John F Bridges; David P Cosgrove; Luis A Diaz; Daniel A Laheru; Joseph M Herman; Richard D Schulick; Barish H Edil; Christopher L Wolfgang; Michael A Choti; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2012-08-09 Impact factor: 5.344
Authors: Vincent W T Lam; Calista Spiro; Jerome M Laurence; Emma Johnston; Michael J Hollands; Henry C C Pleass; Arthur J Richardson Journal: Ann Surg Oncol Date: 2011-09-16 Impact factor: 5.344
Authors: K Homayounfar; A Bleckmann; H-J Helms; F Lordick; J Rüschoff; L-C Conradi; T Sprenger; M Ghadimi; T Liersch Journal: Br J Surg Date: 2014-02-20 Impact factor: 6.939
Authors: Hari Nathan; John F P Bridges; Richard D Schulick; Andrew M Cameron; Kenzo Hirose; Barish H Edil; Christopher L Wolfgang; Dorry L Segev; Michael A Choti; Timothy M Pawlik Journal: J Clin Oncol Date: 2011-01-04 Impact factor: 44.544
Authors: Waleed M Mohammad; Guillaume Martel; Richard Mimeault; Robert J Fairfull-Smith; Rebecca C Auer; Fady K Balaa Journal: HPB (Oxford) Date: 2012-02-09 Impact factor: 3.647
Authors: R P Jones; J-N Vauthey; R Adam; M Rees; D Berry; R Jackson; N Grimes; S W Fenwick; G J Poston; H Z Malik Journal: Br J Surg Date: 2012-09 Impact factor: 6.939
Authors: Julie N Leal; Alexsander K Bressan; Neeta Vachharajani; Mithat Gonen; T Peter Kingham; Michael I D'Angelica; Peter J Allen; Ronald P DeMatteo; Majella B M Doyle; Oliver F Bathe; Paul D Greig; Alice Wei; William C Chapman; Elijah Dixon; William R Jarnagin Journal: J Am Coll Surg Date: 2016-01-30 Impact factor: 6.113