Povilas Ignatavicius1, Christian E Oberkofler1, William C Chapman2, Ronald P DeMatteo3, Bryan M Clary4, Michael I D'Angelica5, Kenneth K Tanabe6, Johnny C Hong7, Thomas A Aloia8, Timothy M Pawlik9, Roberto Hernandez-Alejandro10, Shimul A Shah11, Jean-Nicolas Vauthey8, Guido Torzilli12, Hauke Lang13, Pål-Dag Line14, Olivier Soubrane15, Hugo Pinto-Marques16, Ricardo Robles-Campos17, Karim Boudjema18, Peter Lodge19, René Adam20, Christian Toso21, Alejandro Serrablo22, Luca Aldrighetti23, Michelle L DeOliveira1, Philipp Dutkowski1, Henrik Petrowsky1, Michael Linecker1, Cäcilia S Reiner24, Julia Braun25, Ruslan Alikhanov26, Giedrius Barauskas27, Albert C Y Chan28, Jiahong Dong29, Norihiro Kokudo30, Masakazu Yamamoto31, Koo Jeong Kang32, Yuman Fong33, Mohamed Rela34, Xabier De Aretxabala35, Eduardo De Santibañes36, Miguel Ángel Mercado37, Oscar C Andriani38, Orlando Jorge M Torres39, Antonio D Pinna40, Pierre-Alain Clavien1. 1. Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland. 2. Department of Surgery and Transplantation, Washington University School of Medicine, Washington. 3. Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 4. Department of Surgery, University of California at San Diego, San Diego. 5. Department of Surgery, MSKCC New York, New York. 6. Department of Surgery, Massachusetts General Hospital, Boston. 7. Department of Surgery and Transplantation, Medical College of Wisconsin, Wisconsin. 8. Department of Surgery, MD Anderson Cancer Center, Houston. 9. Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH. 10. Division of Transplantation and Hepatobiliary Surgery, University of Rochester, NY. 11. Department of Surgery and Transplantation, University of Cincinnati College of Medicine, Cincinnati. 12. Department of Surgery and Transplantation, Humanitas University Milan, Milan, Italy. 13. Department of Surgery and Transplantation, University Hospital Mainz, Mainz, Germany. 14. Department of Transplantation Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway. 15. Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, France. 16. Department of Surgery and Transplantation, Centro Hospitalar de Lisboa Central, Lisboa, Portugal. 17. Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain. 18. Department of Hepatobiliary and Digestive Surgery, Hospital Pontchaillou, University of Rennes 1, Rennes, France. 19. Department of Surgery and Transplantation, St. James's University Hospital, Leeds, United Kingdom. 20. Centre Hepato-Biliaire, Hôpital Paul Brousse, Villejuif, France. 21. Division of Abdominal Surgery, Geneva University Hospitals, Geneva, Switzerland. 22. Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain. 23. Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy. 24. Department of Radiology, University Hospital Zurich, Zurich, Switzerland. 25. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland. 26. Department of Surgery and Transplantation, Moscow Clinical Scientific Center, Moscow, Russian Federation. 27. Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania. 28. Department of Surgery, The University of Hong Kong, Hong Kong. 29. Department of Surgery and Transplantation, Beijing Tsinghua Changgung Hospital, Beijing, China. 30. Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan. 31. Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 32. Division of HBP Surgery, Department of Surgery, Keimyung University Dong-San Hospital Daegu, South Korea. 33. Department of Surgery, City of Hope Medical Center, Duarte, United States. 34. Department of Surgery and Transplantation, Dr. Rela Institute & Medical Centre Chennai, Chennai, India. 35. Department of Surgery and Transplantation, Clinica Alemana Santiago Chile, University del Desarrollo, Santiago, Chile. 36. Department of Surgery and Transplantation, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 37. Department of Surgery and Transplantation, Instituto Nacional de Ciencias Medicas y Nutricion, Mexico. 38. Oncosurgical HPB Surgery of Sanatorio de los Arcos, Swiss Medical Group, Buenos Aires, Argentina. 39. Department of hepatopancreatobiliary surgery and transplantation, University of Maranhao, São Luis, Brazil. 40. Department of Surgery and Transplantation, University of Bologna, Bologna, Italy.
Abstract
OBJECTIVE: To test the degree of agreement in selecting therapeutic options for patients suffering from colorectal liver metastasis (CRLM) among surgical experts around the globe. SUMMARY/ BACKGROUND: Only few areas in medicine have seen so many novel therapeutic options over the past decades as for liver tumors. Significant variations may therefore exist regarding the choices of treatment, even among experts, which may confuse both the medical community and patients. METHODS: Ten cases of CRLM with different levels of complexity were presented to 43 expert liver surgeons from 23 countries and 4 continents. Experts were defined as experienced surgeons with academic contributions to the field of liver tumors. Experts provided information on their medical education and current practice in liver surgery and transplantation. Using an online platform, they chose their strategy in treating each case from defined multiple choices with added comments. Inter-rater agreement among experts and cases was calculated using free-marginal multirater kappa methodology. A similar, but adjusted survey was presented to 60 general surgeons from Asia, Europe, and North America to test their attitude in treating or referring complex patients to expert centers. RESULTS: Thirty-eight (88%) experts completed the evaluation. Most of them are in leading positions (92%) with a median clinical experience of 25 years. Agreement on therapeutic strategies among them was none to minimal in more than half of the cases with kappa varying from 0.00 to 0.39. Many general surgeons may not refer the complex cases to expert centers, including in Europe, where they also engage in complex liver surgeries. CONCLUSIONS: Considerable inconsistencies of decision-making exist among expert surgeons when choosing a therapeutic strategy for CRLM. This might confuse both patients and referring physicians and indicate that an international high-level consensus statements and widely accepted guidelines are needed.
OBJECTIVE: To test the degree of agreement in selecting therapeutic options for patients suffering from colorectal liver metastasis (CRLM) among surgical experts around the globe. SUMMARY/ BACKGROUND: Only few areas in medicine have seen so many novel therapeutic options over the past decades as for liver tumors. Significant variations may therefore exist regarding the choices of treatment, even among experts, which may confuse both the medical community and patients. METHODS: Ten cases of CRLM with different levels of complexity were presented to 43 expert liver surgeons from 23 countries and 4 continents. Experts were defined as experienced surgeons with academic contributions to the field of liver tumors. Experts provided information on their medical education and current practice in liver surgery and transplantation. Using an online platform, they chose their strategy in treating each case from defined multiple choices with added comments. Inter-rater agreement among experts and cases was calculated using free-marginal multirater kappa methodology. A similar, but adjusted survey was presented to 60 general surgeons from Asia, Europe, and North America to test their attitude in treating or referring complex patients to expert centers. RESULTS: Thirty-eight (88%) experts completed the evaluation. Most of them are in leading positions (92%) with a median clinical experience of 25 years. Agreement on therapeutic strategies among them was none to minimal in more than half of the cases with kappa varying from 0.00 to 0.39. Many general surgeons may not refer the complex cases to expert centers, including in Europe, where they also engage in complex liver surgeries. CONCLUSIONS: Considerable inconsistencies of decision-making exist among expert surgeons when choosing a therapeutic strategy for CRLM. This might confuse both patients and referring physicians and indicate that an international high-level consensus statements and widely accepted guidelines are needed.
Authors: Shahid Ahmed; Nicholas Bosma; Michael Moser; Shahida Ahmed; Bryan Brunet; Janine Davies; Corinne Doll; Dorie-Anna Dueck; Christina A Kim; Shuying Ji; Duc Le; Richard Lee-Ying; Howard Lim; John Paul McGhie; Karen Mulder; Jason Park; Deepti Ravi; Daniel J Renouf; Devin Schellenberg; Ralph P W Wong; Adnan Zaidi Journal: Curr Oncol Date: 2022-03-08 Impact factor: 3.677