TY - JOUR
T1 - Outcomes of Resectability Assessment of the Dutch Colorectal Cancer Group Liver Metastases Expert Panel
AU - Dutch Colorectal Cancer Group
AU - Huiskens, Joost
AU - Bolhuis, Karen
AU - Engelbrecht, Marc RW
AU - De Jong, Koert P.
AU - Kazemier, Geert
AU - Liem, Mike SL
AU - Verhoef, Cornelis
AU - de Wilt, Johannes HW
AU - Punt, Cornelis JA
AU - van Gulik, Thomas M.
AU - Van Amerongen, M. J.
AU - Dejong, Cornelis HC
AU - Gerhards, Michael F.
AU - Grunhagen, Dirk
AU - Heijmen, Linda
AU - Hermans, John J.
AU - Keijser, Astrid
AU - Klaase, Joost M.
AU - Van Lienden, Krijn P.
AU - Molenaar, Quintus I.
AU - Patijn, Gijs A.
AU - Rijken, Arjen M.
AU - Ruers, Theo M.
AU - Swijnenburg, Rutger Jan
AU - van Tinteren, Harm
N1 - Publisher Copyright:
© 2019 American College of Surgeons
PY - 2019/12
Y1 - 2019/12
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85074321276&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2019.08.1445
DO - 10.1016/j.jamcollsurg.2019.08.1445
M3 - Article
C2 - 31520695
AN - SCOPUS:85074321276
SN - 1072-7515
VL - 229
SP - 523-532.e2
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 6
ER -