Joost Huiskens1, Karen Bolhuis2, Marc Rw Engelbrecht3, Koert P De Jong4, Geert Kazemier5, Mike Sl Liem6, Cornelis Verhoef7, Johannes Hw de Wilt8, Cornelis Ja Punt9, Thomas M van Gulik10. 1. Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 2. Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: k.bolhuis@amsterdamumc.nl. 3. Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 4. Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 5. Department of Surgery, Amsterdam UMC, VU University, Cancer Center Amsterdam, Amsterdam, The Netherlands. 6. Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands. 7. Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. 8. Department of Surgery, Radboud UMC, Nijmegen, The Netherlands. 9. Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 10. Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Decision making on optimal treatment strategy in patients with initially unresectable colorectal cancer liver metastases (CRLM) remains complex because uniform criteria for (un)resectability are lacking. This study reports on the feasibility and short-term outcomes of The Dutch Colorectal Cancer Group Liver Expert Panel. STUDY DESIGN: The Expert Panel consists of 13 hepatobiliary surgeons and 4 radiologists. Resectability assessment is performed independently by 3 randomly assigned surgeons, and CRLM are scored as resectable, potentially resectable, or permanently unresectable. In absence of consensus, 2 additional surgeons are invited for a majority consensus. Patients with potentially resectable or unresectable CRLM at baseline are evaluated every 2 months of systemic therapy. Once CRLM are considered resectable, a treatment strategy is proposed. RESULTS: Overall, 398 panel evaluations in 183 patients were analyzed. The median time to panel conclusion was 7 days (interquartile range [IQR] 5-11 days). Intersurgeon disagreement was observed in 205 (52%) evaluations, with major disagreement (resectable vs permanently unresectable) in 42 (11%) evaluations. After systemic treatment, 106 patients were considered to have resectable CRLM, 84 of whom (79%) underwent a curative procedure. R0 resection (n = 41), R0 resection in combination with ablative treatment (n = 26), or ablative treatment only (n = 4) was achieved in 67 of 84 (80%) patients. CONCLUSIONS: This study analyzed prospective resectability evaluation of patients with CRLM by a panel of radiologists and liver surgeons. The high rate of disagreement among experienced liver surgeons reflects the complexity in defining treatment strategies for CRLM and supports the use of a panel rather than a single-surgeon decision.
RCT Entities:
BACKGROUND: Decision making on optimal treatment strategy in patients with initially unresectable colorectal cancer liver metastases (CRLM) remains complex because uniform criteria for (un)resectability are lacking. This study reports on the feasibility and short-term outcomes of The Dutch Colorectal Cancer Group Liver Expert Panel. STUDY DESIGN: The Expert Panel consists of 13 hepatobiliary surgeons and 4 radiologists. Resectability assessment is performed independently by 3 randomly assigned surgeons, and CRLM are scored as resectable, potentially resectable, or permanently unresectable. In absence of consensus, 2 additional surgeons are invited for a majority consensus. Patients with potentially resectable or unresectable CRLM at baseline are evaluated every 2 months of systemic therapy. Once CRLM are considered resectable, a treatment strategy is proposed. RESULTS: Overall, 398 panel evaluations in 183 patients were analyzed. The median time to panel conclusion was 7 days (interquartile range [IQR] 5-11 days). Intersurgeon disagreement was observed in 205 (52%) evaluations, with major disagreement (resectable vs permanently unresectable) in 42 (11%) evaluations. After systemic treatment, 106 patients were considered to have resectable CRLM, 84 of whom (79%) underwent a curative procedure. R0 resection (n = 41), R0 resection in combination with ablative treatment (n = 26), or ablative treatment only (n = 4) was achieved in 67 of 84 (80%) patients. CONCLUSIONS: This study analyzed prospective resectability evaluation of patients with CRLM by a panel of radiologists and liver surgeons. The high rate of disagreement among experienced liver surgeons reflects the complexity in defining treatment strategies for CRLM and supports the use of a panel rather than a single-surgeon decision.
Authors: Pia Osterlund; Tapio Salminen; Leena-Maija Soveri; Raija Kallio; Ilmo Kellokumpu; Annamarja Lamminmäki; Päivi Halonen; Raija Ristamäki; Eila Lantto; Aki Uutela; Emerik Osterlund; Ali Ovissi; Arno Nordin; Eetu Heervä; Kaisa Lehtomäki; Jari Räsänen; Maija Murashev; Laura Aroviita; Antti Jekunen; Reneé Lindvall-Andersson; Paul Nyandoto; Juha Kononen; Anna Lepistö; Tuija Poussa; Timo Muhonen; Annika Ålgars; Helena Isoniemi Journal: Lancet Reg Health Eur Date: 2021-01-29