View in EDS

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: Analysis of the Liver Expert Panel of the Dutch Colorectal Cancer Group

Saved in:
Bibliographic Details
Title: 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: Analysis of the Liver Expert Panel of the Dutch Colorectal Cancer Group
Authors: Bond, Marinde J. G., Kuiper, Babette I., van Gulik, Thomas, Hermans, John J., de Jong, Koert P., Klaase, Joost M., Kok, Niels F. M., Leclercq, Wouter K. G., Liem, Mike S. L., van Lienden, Krijn P., Molenaar, I. Quintus, Neumann, Ulf P., Bolhuis, Karen, Patijn, Gijs A., Rijken, Arjen M., Ruers, Theo M., Verhoef, Cornelis, de Wilt, Johannes H. W., Kazemier, Geert, May, Anne M., Punt, Cornelis J. A., Swijnenburg, Rutger-Jan, Komurcu, Aysun, van Amerongen, Martinus J., Chapelle, Thiery, Dejong, Cornelis H. C., Engelbrecht, Marc R. W., Gerhards, Michael F., Grünhagen, Dirk J.
Contributors: Epi Kanker Team B, Cancer, MS CGO, Epi Kanker, JC onderzoeksprogramma Cancer
Source: Ann Surg Oncol
Bond, M J G, Kuiper, B I, Bolhuis, K, Komurcu, A, van Amerongen, M J, Chapelle, T, Dejong, C H C, Engelbrecht, M R W, Gerhards, M F, Grünhagen, D J, van Gulik, T, Hermans, J J, de Jong, K P, Klaase, J M, Kok, N F M, Leclercq, W K G, Liem, M S L, van Lienden, K P, Molenaar, I Q, Neumann, U P, Patijn, G A, Rijken, A M, Ruers, T M, Verhoef, C, de Wilt, J H W, Kazemier, G, May, A M, Punt, C J A & Swijnenburg, R-J 2023, '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', Annals of Surgical Oncology, vol. 30, no. 9, pp. 5376-5385. https://doi.org/10.1245/s10434-023-13510-7
Annals of Surgical Oncology, 30, 9, pp. 5376-5385
Annals of surgical oncology
Annals of surgical oncology 30(9), 5376-5385 (2023). doi:10.1245/s10434-023-13510-7
Publisher Information: Springer Science and Business Media LLC, 2023.
Publication Year: 2023
Subject Terms: OUTCOMES, STRATEGIES, SURGERY, BEVACIZUMAB, Liver Neoplasms, Radboudumc 9: Rare cancers RIHS: Radboud Institute for Health Sciences, CHEMOTHERAPY, Radboudumc 14: Tumours of the digestive tract RIHS: Radboud Institute for Health Sciences, 3. Good health, All institutes and research themes of the Radboud University Medical Center, Oncology, SDG 3 - Good Health and Well-being, PLUS, Hepatobiliary Tumors, Journal Article, Humans, Hepatectomy, Surgery, Human medicine, Colorectal Neoplasms
Description: 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-based decisions, and the need for consensus guidelines on resectability criteria and technical approach to prevent unwarranted variability in clinical practice.
Document Type: Article
Other literature type
File Description: application/pdf
Language: English
ISSN: 1534-4681
1068-9265
DOI: 10.1245/s10434-023-13510-7
DOI: 10.18154/rwth-conv-251972
Access URL: https://pubmed.ncbi.nlm.nih.gov/37118612
https://hdl.handle.net/https://repository.ubn.ru.nl/handle/2066/295971
https://hdl.handle.net/11370/53bff1bb-a6fc-4807-a34a-0b627748f86a
https://doi.org/10.1245/s10434-023-13510-7
https://research.rug.nl/en/publications/53bff1bb-a6fc-4807-a34a-0b627748f86a
https://cris.maastrichtuniversity.nl/en/publications/a1fd96a4-7504-4309-ab91-f951f5672dda
https://doi.org/10.1245/s10434-023-13510-7
https://research.vumc.nl/en/publications/201d8ee0-c89c-4716-a070-8b38004312b8
https://dspace.library.uu.nl/handle/1874/449073
https://pure.amsterdamumc.nl/en/publications/23b2bc46-2f59-4eda-bf9f-8271f0c29e22
https://doi.org/10.1245/s10434-023-13510-7
https://repository.ubn.ru.nl//bitstream/handle/2066/295971/295971.pdf
https://repository.ubn.ru.nl/handle/2066/295971
https://hdl.handle.net/10067/1974940151162165141
https://repository.uantwerpen.be/docstore/d:irua:18420
https://publications.rwth-aachen.de/record/981896
Rights: CC BY
URL: http://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (http://creativecommons.org/licenses/by/4.0/) .
Accession Number: edsair.doi.dedup.....e45c6476df50df7ff29d5cb63a933bb6
Database: OpenAIRE
Description
Abstract: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-based decisions, and the need for consensus guidelines on resectability criteria and technical approach to prevent unwarranted variability in clinical practice.
ISSN:15344681
10689265
DOI:10.1245/s10434-023-13510-7