Intersurgeon Variability in Local Treatment Planning for Patients with Initially Unresectable Colorectal Cancer Liver Metastases: Analysis of the Liver Expert Panel of the Dutch Colorectal Cancer Group

被引：10

作者：

Bond, Marinde J. G. ^{[1
]}

Kuiper, Babette I. ^{[2
,3
,24
]}

Bolhuis, Karen ^{[4
,5
]}

Komurcu, Aysun ^{[6
]}

van Amerongen, Martinus J. ^{[7
]}

Chapelle, Thiery ^{[8
]}

Dejong, Cornelis H. C. ^{[9
,10
]}

Engelbrecht, Marc R. W. ^{[11
]}

Gerhards, Michael F. ^{[12
]}

Grunhagen, Dirk J. ^{[13
]}

van Gulik, Thomas ^{[2
,3
]}

Hermans, John J. ^{[14
]}

de Jong, Koert P. ^{[15
]}

Klaase, Joost M. ^{[15
]}

Kok, Niels F. M. ^{[16
]}

Leclercq, Wouter K. G. ^{[17
]}

Liem, Mike S. L. ^{[18
]}

van Lienden, Krijn P. ^{[19
]}

Molenaar, I. Quintus ^{[20
]}

Neumann, Ulf P. ^{[9
,10
]}

Patijn, Gijs A. ^{[21
]}

Rijken, Arjen M. ^{[22
]}

Ruers, Theo M. ^{[16
]}

Verhoef, Cornelis ^{[13
]}

de Wilt, Johannes H. W. ^{[23
]}

Kazemier, Geert ^{[2
,3
,24
]}

May, Anne M. ^{[1
]}

Punt, Cornelis J. A. ^{[1
,4
]}

Swijnenburg, Rutger-Jan ^{[2
,3
,24
]}

机构：

[1] Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Dept Epidemiol, Utrecht, Netherlands

[2] Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands

[3] Vrije Univ Amsterdam, Amsterdam, Netherlands

[4] Amsterdam UMC, Canc Ctr Amsterdam, Dept Med Oncol, Amsterdam, Netherlands

[5] Netherlands Canc Inst, Dept Gastrointestinal Oncol, Amsterdam, Netherlands

[6] Netherlands Comprehens Canc Ctr, Utrecht, Netherlands

[7] Sint Maartensklin, Dept Radiol, Nijmegen, Netherlands

[8] Antwerp Univ Hosp, Dept Hepatobiliary Transplantat & Endocrine Surg, Antwerp, Belgium

[9] Maastricht Univ, Dept Surg, Med Ctr, Maastricht, Netherlands

[10] Univ Klinikum Aachen, Aachen, Germany

[11] Amsterdam UMC, Dept Radiol & Nucl Med, Amsterdam, Netherlands

[12] OLVG Hosp, Dept Surg, Amsterdam, Netherlands

[13] Erasmus MC Canc Inst, Dept Surg, Rotterdam, Netherlands

[14] Radboud Univ Nijmegen, Dept Radiol, Med Ctr, Nijmegen, Netherlands

[15] Univ Med Ctr Groningen, Dept Hepatobiliary Surg & Liver Transplantat, Groningen, Netherlands

[16] Netherlands Canc Inst, Dept Surg, Amsterdam, Netherlands

[17] Maxima Med Ctr, Dept Surg, Veldhoven, Netherlands

[18] Med Spectrum Twente, Dept Surg, Enschede, Netherlands

[19] St Antonius Hosp, Dept Radiol, Nieuwegein, Netherlands

[20] Univ Med Ctr Utrecht, Dept Surg, Utrecht, Netherlands

[21] Isala Hosp, Dept Surg, Zwolle, Netherlands

[22] Amphia Hosp, Dept Surg, Breda, Netherlands

[23] Radboud Univ Nijmegen, Dept Surg, Med Ctr, Nijmegen, Netherlands

[24] Canc Ctr Amsterdam, Amsterdam, Netherlands

来源：

ANNALS OF SURGICAL ONCOLOGY | 2023年 / 30卷 / 09期

关键词：

CHEMOTHERAPY; PLUS; BEVACIZUMAB; STRATEGIES; OUTCOMES; SURGERY;

D O I：

10.1245/s10434-023-13510-7

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background Consensus on resectability criteria for colorectal cancer liver metastases (CRLM) is lacking, resulting in differences in therapeutic strategies. This study evaluated variability of resectability assessments and local treatment plans for patients with initially unresectable CRLM by the liver expert panel from the randomised phase III CAIRO5 study.Methods The liver panel, comprising surgeons and radiologists, evaluated resectability by predefined criteria at baseline and 2-monthly thereafter. If surgeons judged CRLM as resectable, detailed local treatment plans were provided. The panel chair determined the conclusion of resectability status and local treatment advice, and forwarded it to local surgeons.Results A total of 1149 panel evaluations of 496 patients were included. Intersurgeon disagreement was observed in 50% of evaluations and was lower at baseline than follow-up (36% vs. 60%, p < 0.001). Among surgeons in general, votes for resectable CRLM at baseline and follow-up ranged between 0-12% and 27-62%, and for permanently unresectable CRLM between 3-40% and 6-47%, respectively. Surgeons proposed different local treatment plans in 77% of patients. The most pronounced intersurgeon differences concerned the advice to proceed with hemihepatectomy versus parenchymal-preserving approaches. Eighty-four percent of patients judged by the panel as having resectable CRLM indeed received local treatment. Local surgeons followed the technical plan proposed by the panel in 40% of patients.Conclusion Considerable variability exists among expert liver surgeons in assessing resectability and local treatment planning of initially unresectable CRLM. This stresses the value of panel-baseddecisions, and the need for consensus guidelines on resectability criteria and technical approach to prevent unwarranted variability in clinical practice.

引用

页码：5376 / 5385

页数：10

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