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Surgical Resection Preferences and Perceptions among Medical Oncologists Treating Liver Metastases from Colorectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Liver resection is a key therapeutic strategy to improve survival in patients with colorectal cancer liver metastases. Underutilization may negatively affect outcomes. Using a Web-based survey and standardized imaging scenarios, this study assessed medical oncologists’ (MOs) perceptions of resectability, preferences for chemotherapy sequencing, and referral for surgical consultation in a static patient profile of good performance status and no extrahepatic spread but varying bulk and distribution of disease.

Methods

A total of 190 US-based MOs were surveyed. A single patient profile was created and combined with 10 different sets of liver computed tomographic images displaying a broad spectrum of metastases. Assessments of resectability and ranking were compared with the results obtained from an expert panel of 3 hepatic surgeons.

Results

The expert hepatic surgeons designated 8 scans resectable, 1 borderline resectable/convertible, and 1 unresectable. In the 8 resectable cases, 34.4 % of MOS perceived the case to be initially resectable, 41.7 % potentially resectable after chemotherapy response, and 23.9 % unresectable. Increasing number of lesions, larger tumor diameter, and bilateral disease were associated with lower resectability perception (P < 0.01). Among those cases considered resectable by MOs, they preferred initial resection (54.2 %) over neoadjuvant chemotherapy (38.4 %). Initial referral for surgical consultation was generally favored only for cases considered initially resectable by MOs.

Conclusions

This study confirms both potential discrepancies between MOs’ and hepatic surgeons’ perception of resectability and underutilization of early surgical consultation for patients with potentially resectable colorectal cancer liver metastases and underscores the importance of an evaluation that includes an experienced hepatic surgeon.

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References

  1. de Jong MC, Pulitano C, Ribero D, Strub J, Mentha G, Schulick RG, et al. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. Ann Surg. 2009;250:440–8.

    PubMed  Google Scholar 

  2. Tomlinson JS, Jarnagin WR, DeMatteo RP, Fong Y, Kornprat P, Gonen M, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25:4575–80.

    Article  PubMed  Google Scholar 

  3. Bismuth H, Adam R, Levi F, Farabos C, Waechter F, Castaing D, et al. Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg. 1996;224:509–22.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  4. Minagawa M, Makuuchi M, Torzilli G, Takayama T, Kawasaki S, Kosuge T, et al. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg. 2000;231:487–99.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  5. Adam R, De Gramont A, Figueras J, Guthrie A, Kokudo N, Kunstlinger F, et al. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist. 2012;17:1225–39.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. National Comprehensive Cancer Network. Clinical practice guidelines in oncology. Colon cancer. Version 2.2015. 2014. p. 1–143.

    Google Scholar 

  7. Nathan H, Bridges JF, Cosgrove DP, Diaz LA Jr, Laheru DA, Herman,JM, et al. Treating patients with colon cancer liver metastasis: a nationwide analysis of therapeutic decision making. Ann Surg Oncol. 2012;19:3668–76.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Riall TS, Lillemoe KD. Underutilization of surgical resection in patients with localized pancreatic cancer. Ann Surg. 2007;246:181–2.

    Article  PubMed  PubMed Central  Google Scholar 

  9. House MG, Ito H, Gonen M, Fong Y, Allen PJ, DeMatteo RP, et al. Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1,600 patients during two decades at a single institution. J Am Coll Surg. 2010;210:744–55.

    Article  PubMed  Google Scholar 

  10. Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A, Eng C, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241:715–24.

    Article  PubMed  PubMed Central  Google Scholar 

  11. de Haas RJ, Wicherts DA, Andreani P, Pascal G, Saliba F, Ichai P, et al. Impact of expanding criteria for resectability of colorectal metastases on short- and long-term outcomes after hepatic resection. Ann Surg. 2011;253:1069–79.

    Article  PubMed  Google Scholar 

  12. Lehmann K, Rickenbacher A, Weber A, Pestalozzi BC, Clavien PA. Chemotherapy before liver resection of colorectal metastases: friend or foe? Ann Surg. 2012;255:237–47.

    Article  PubMed  Google Scholar 

  13. Mayo SC, Heckman JE, Shore AD, Nathan H, Parikh AA, Bridges JF, et al. Shifting trends in liver-directed management of patients with colorectal liver metastasis: a population-based analysis. Surgery. 2011;150:204–16.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nanji S, Cleary S, Ryan P, Guindi M, Selvarajah S, Grieg P, et al. Up-front hepatic resection for metastatic colorectal cancer results in favorable long-term survival. Ann Surg Oncol. 2013;20:295–304.

    Article  PubMed  Google Scholar 

  15. Nordlinger B, Vauthey JN, Poston G, Benoist S, Rougier P, Van Cutsem E. The timing of chemotherapy and surgery for the treatment of colorectal liver metastases. Clin Colorectal Cancer. 2010;9:212–8.

    Article  PubMed  CAS  Google Scholar 

  16. Ksienski D, Woods R, Speers C, Kennecke H. Patterns of referral and resection among patients with liver-only metastatic colorectal cancer (MCRC). Ann Surg Oncol. 2010;17:3085–93.

    Article  PubMed  Google Scholar 

  17. Wei AC, Sandhu L, Devitt KS, Gagliardi AR, Kennedy ED, Urbach DR, et al. Practice patterns for the management of hepatic metastases from colorectal cancer: a mixed methods analysis. Ann Surg Oncol. 2013;20:1567–74.

    Article  PubMed  Google Scholar 

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Acknowledgments

Supported by Bristol Myers Squibb.

Disclosure

M.G., M.T., and M.E. are employees of Xcenda LLC. M.C. has received consultancy fees from Bayer Healthcare. S.W. is a former employee of Bristol Myers Squibb. The other authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA

    Michael A. Choti MD, MBA

  2. Xcenda LLC, AmerisourceBergen Consulting Services, Palm Harbor, FL, USA

    Michele Thomas MS, MBA, Michael Eaddy PharmD, PhD, Jonathan Kish PhD, MPH & Mark R. Green MD

  3. Bristol-Myers Squibb, Plainsboro, NJ, USA

    Schiffon L. Wong MPH

  4. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Timothy M. Pawlik MD, MPH, PhD, Kenzo Hirose MD & Matthew J. Weiss MD

Authors
  1. Michael A. Choti MD, MBA
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  2. Michele Thomas MS, MBA
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  3. Schiffon L. Wong MPH
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  4. Michael Eaddy PharmD, PhD
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  5. Timothy M. Pawlik MD, MPH, PhD
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  6. Kenzo Hirose MD
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  7. Matthew J. Weiss MD
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  8. Jonathan Kish PhD, MPH
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  9. Mark R. Green MD
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Corresponding author

Correspondence to Michael A. Choti MD, MBA.

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Choti, M.A., Thomas, M., Wong, S.L. et al. Surgical Resection Preferences and Perceptions among Medical Oncologists Treating Liver Metastases from Colorectal Cancer. Ann Surg Oncol 23, 375–381 (2016). https://doi.org/10.1245/s10434-015-4925-1

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  • DOI: https://doi.org/10.1245/s10434-015-4925-1

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