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
Bond, Marinde J G; Kuiper, Babette I; Bolhuis, Karen; Komurcu, Aysun; van Amerongen, Martinus J; Chapelle, Thiery; Dejong, Cornelis H C; Engelbrecht, Marc R W; Gerhards, Michael F; Grünhagen, Dirk J; 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; 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
(2023) Annals of Surgical Oncology, volume 30, issue 9, pp. 5376 - 5385
(Article)
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
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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.
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Keywords: Oncology, Surgery, Journal Article
ISSN: 1068-9265
Publisher: Springer New York
Note: Funding Information: The CAIRO5 study is supported by unrestricted scientific grants from Roche and Amgen. The funders had no role in the design, conduct, or submission of the study, nor in the decision to submit the manuscript for publication. We had complete access to all study data that support the manuscript. Funding Information: We would like to thank all patients and their families, and hospitals and their research teams, for participating in the CAIRO5 study. We would like to acknowledge the Netherlands comprehensive cancer organisation (IKNL) for their collaboration. Publisher Copyright: © 2023, The Author(s).
(Peer reviewed)
