Eduardo A Vega1, Omid Salehi1, Diana Nicolaescu2, Edward-Michael Dussom1, Sylvia V Alarcon3, Olga Kozyreva3, Jana Simonds1, Deborah Schnipper1, Claudius Conrad4. 1. Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA. 2. IOSUD Titu Maiorescu University of Bucharest, Medical Doctoral School, Tulcea Emergency Hospital, Bucharest, Romania. 3. Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. 4. Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA. claudius.conrad@steward.org.
Abstract
BACKGROUND: Lack of a liver surgeon (LS) may lead to failure to cure in patients with possibly resectable colorectal liver metastases (CRLM). This study aims to quantify the failure-to-cure rate due to noninclusion of an LS. PATIENTS AND METHODS: All patients who underwent chemotherapy with palliative intent for CRLM at a community oncology network between 2010 and 2018 were identified from a prospectively maintained cancer registry. Two LS blinded to patient management and outcome reviewed pretreatment imaging and assigned each scan a newly developed resectability score. Nominal group technique and independent scores were combined to determine probability of curative-intent resection. Interobserver agreement was calculated using κ testing. RESULTS: This study included 72 palliative CRLM patients. Demographic factors were: 44 (59%) male, median age 68 years (range 36-94 years), 23 (32%) rectal primary, 24 (33%) receiving oxaliplatin-based chemotherapy. Of the 72 patients with CRLM, 6 had left-sided metastases only. The median number of CRLM was 6 (1-8). Agreement on resectability was achieved in 32 (44%) patients for the entire cohort and 17 (54%) in patients without extrahepatic disease. A lower median number of CRLM was found in the group considered to be resectable by the two LS (2 versus 8; p = 0.001). Substantial agreement was found between liver surgeons in the group of patients without extrahepatic disease (κ = 0.9043). CONCLUSIONS: Over 44% of patients who were assigned palliative chemotherapy at tumor boards without an LS were considered potentially resectable upon independent LS review.
BACKGROUND: Lack of a liver surgeon (LS) may lead to failure to cure in patients with possibly resectable colorectal liver metastases (CRLM). This study aims to quantify the failure-to-cure rate due to noninclusion of an LS. PATIENTS AND METHODS: All patients who underwent chemotherapy with palliative intent for CRLM at a community oncology network between 2010 and 2018 were identified from a prospectively maintained cancer registry. Two LS blinded to patient management and outcome reviewed pretreatment imaging and assigned each scan a newly developed resectability score. Nominal group technique and independent scores were combined to determine probability of curative-intent resection. Interobserver agreement was calculated using κ testing. RESULTS: This study included 72 palliative CRLM patients. Demographic factors were: 44 (59%) male, median age 68 years (range 36-94 years), 23 (32%) rectal primary, 24 (33%) receiving oxaliplatin-based chemotherapy. Of the 72 patients with CRLM, 6 had left-sided metastases only. The median number of CRLM was 6 (1-8). Agreement on resectability was achieved in 32 (44%) patients for the entire cohort and 17 (54%) in patients without extrahepatic disease. A lower median number of CRLM was found in the group considered to be resectable by the two LS (2 versus 8; p = 0.001). Substantial agreement was found between liver surgeons in the group of patients without extrahepatic disease (κ = 0.9043). CONCLUSIONS: Over 44% of patients who were assigned palliative chemotherapy at tumor boards without an LS were considered potentially resectable upon independent LS review.
Authors: R Adam; E Avisar; A Ariche; S Giachetti; D Azoulay; D Castaing; F Kunstlinger; F Levi; F Bismuth Journal: Ann Surg Oncol Date: 2001-05 Impact factor: 5.344
Authors: Scott Kopetz; George J Chang; Michael J Overman; Cathy Eng; Daniel J Sargent; David W Larson; Axel Grothey; Jean-Nicolas Vauthey; David M Nagorney; Robert R McWilliams Journal: J Clin Oncol Date: 2009-05-26 Impact factor: 44.544
Authors: C Bokemeyer; I Bondarenko; J T Hartmann; F de Braud; G Schuch; A Zubel; I Celik; M Schlichting; P Koralewski Journal: Ann Oncol Date: 2011-01-12 Impact factor: 32.976
Authors: Eric Van Cutsem; Claus-Henning Köhne; István Láng; Gunnar Folprecht; Marek P Nowacki; Stefano Cascinu; Igor Shchepotin; Joan Maurel; David Cunningham; Sabine Tejpar; Michael Schlichting; Angela Zubel; Ilhan Celik; Philippe Rougier; Fortunato Ciardiello Journal: J Clin Oncol Date: 2011-04-18 Impact factor: 44.544
Authors: E J A Morris; D Forman; J D Thomas; P Quirke; E F Taylor; L Fairley; B Cottier; G Poston Journal: Br J Surg Date: 2010-07 Impact factor: 6.939
Authors: G Folprecht; T Gruenberger; W Bechstein; H-R Raab; J Weitz; F Lordick; J T Hartmann; J Stoehlmacher-Williams; H Lang; T Trarbach; T Liersch; D Ockert; D Jaeger; U Steger; T Suedhoff; A Rentsch; C-H Köhne Journal: Ann Oncol Date: 2014-02-27 Impact factor: 32.976
Authors: C Garufi; A Torsello; S Tumolo; G M Ettorre; M Zeuli; C Campanella; G Vennarecci; M Mottolese; I Sperduti; F Cognetti Journal: Br J Cancer Date: 2010-10-19 Impact factor: 7.640
Authors: Eric Van Cutsem; Claus-Henning Köhne; Erika Hitre; Jerzy Zaluski; Chung-Rong Chang Chien; Anatoly Makhson; Geert D'Haens; Tamás Pintér; Robert Lim; György Bodoky; Jae Kyung Roh; Gunnar Folprecht; Paul Ruff; Christopher Stroh; Sabine Tejpar; Michael Schlichting; Johannes Nippgen; Philippe Rougier Journal: N Engl J Med Date: 2009-04-02 Impact factor: 91.245
Authors: Christopher T Aquina; Zachary J Brown; Joal D Beane; Aslam Ejaz; Jordan M Cloyd; Allan Tsung; Mohamed O Adam; Timothy M Pawlik; Alex C Kim Journal: Ann Surg Oncol Date: 2022-09-23 Impact factor: 4.339
Authors: Anastasia Murtha-Lemekhova; Juri Fuchs; Svenja Feiler; Erik Schulz; Miriam Teroerde; Eva Kalkum; Rosa Klotz; Adrian Billeter; Pascal Probst; Katrin Hoffmann Journal: BMC Med Date: 2022-01-28 Impact factor: 8.775