The dilemma of the disappearing colorectal liver metastases: defining international trends in management

Mudassar A Ghazanfar; Amir Abdelhamid; Luca Aldreghetti; Christian Sturesson; Nobuyuki Takemura; Stephanie Truant; Guido Fiorentini; Catherine Teh; Ruslan Alikhanov; Irfan Ahmed; John Hammond; Alessandro Ferrero; Michael Silva; Timothy Pawlik; Robert Jones; Mohamed Bekheit

doi:10.1016/j.hpb.2023.01.003

The dilemma of the disappearing colorectal liver metastases: defining international trends in management

Mudassar A Ghazanfar, Amir Abdelhamid, Luca Aldreghetti, Christian Sturesson, Nobuyuki Takemura, Stephanie Truant, Guido Fiorentini, Catherine Teh, Ruslan Alikhanov, Irfan Ahmed, John Hammond, Alessandro Ferrero, Michael Silva, Timothy Pawlik, Robert Jones, Mohamed Bekheit^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

OBJECTIVE: This survey sought to appraise the degree of consistency in the management of disappeared colorectal liver metastases (dCRLM) among liver surgeons in different countries.

BACKGROUND: Colorectal liver metastases (CRLM) account for half of the deaths secondary to colorectal cancer. Due to the high utilization of chemotherapy before surgery, some or all CRLM can disappear (dCRLM) but management of dCRLMs remains unclear.

METHODS: Seven simulated scenarios of dCRLM were presented to experienced liver surgeons using an online platform. Treatment decisions were submitted and analysed using the multi-rater kappa method. The effect of the experience, complexity of scenarios, and location and number of dCRLM on treatment decision were analysed.

RESULTS: Sixty-seven liver surgeons from 25 countries completed the survey. There was no agreement about the therapeutic strategies of dCRLM in all scenarios (kappa 0.12, IQR 0.20-0.32). In scenarios with lower difficulty scores, surgeons tended to offer surgical resection for dCRLM alongside the visible CRLM (vCRLM), however, with poor agreement (kappa 0.32, IQR 0.19-0.51). No agreement was seen for clinical scenario in which all CRLM lesions disappeared (kappa 0.20).

CONCLUSION: There are clear inconsistencies in the management decisions of dCRLM. Better evidence is required to define optimal management strategies.

Original language	English
Pages (from-to)	446-453
Number of pages	8
Journal	HPB
Volume	25
Issue number	4
Early online date	5 Apr 2023
DOIs	https://doi.org/10.1016/j.hpb.2023.01.003
Publication status	Published - Apr 2023

Bibliographical note

Funding Information:
The authors acknowledge the International Hepato-Pancreato-Biliary Association (IHPBA) for endorsement of the survey. The authors acknowledge the following survey participants:, Enrico Pinotti, Policlinico San Pietro, Italy; Maurizio Romano, General Surgery, Italy; María Jesús Castro Santiago Castro, Hospital Universitario Puerta del Mar. Spain; Mauro Montuori, Policlinico San Pietro, Italy; Dimitrios Magouliotis, University of Thessaly, Greece; Felipe Alconchel, Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Spain; Pablo Rodrigues, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Mario Giuffrida, Parma University Hospital, Italy; Carlos Florez Zorrilla, Centro Medico Nacional 20 de noviembre, Mexico; Amine Benkabbou, Institut national d'oncologie, Morocco; Adianto Nugroho, RSUP Fatmawati, Indonesia; Jonathan Koea, North Shore Hospital, New Zealand; Semra Demirli Atici, University of Health Sciences Tepecik Training and Research Hospital, Turkey; Gabriella Capolupo, Fondazione Policlinico Campus Bio Medico of Rome, Italy; Achilleas Ntinas, European Interbalkan Medical Center, Greece; Guido Fiorentini, Mayo Clinic, United States; Marcello Di Martino, A.O.R.N. Cardarelli, Italy; Francesco Fleres, ASST Valtellina e Alto Lario, Sondrio Hospital, Italy; Marco Serodio, Coimbra's University Hospital, Portugal; Gabriella Capolupo, Fondazione policlinico campus bio medico of Rome, Italy; Asma Sultana, East Lancashire Teaching Hospitals NHS Trust, United Kingdom; Asad Choudhry, SUNY Upstate Medical University, United States; Carlos Domingo-del Pozo, Hospital Dr. Peset, Spain; Amir Abdelhamid, Aberdeen Royal Infirmary, United Kingdom; Sanket Srinivasa, North Shore Hospital, New Zealand; Cornelis Verhoef, Erasmus MC Cancer Institute, Netherlands; Amine Benkabbou, Institut national d'oncologie, CHU Ibn Sina, Morocco; Rafael Garcia, Santa Casa do Pará, Brazil; Gabriella Capolupo, Fondazione Policlinico campus bio medico of Rome, Italy; Filippo Carannante, Fondazione Policlinico Campus Bio-Medico of Rome, Italy; Frederik Berrevoet, Ghent University Hospital, Belgium; Raffaele Galleano, Ospedale San Paolo, Italy; Carlos Florez-Zorrilla, Centro Medico Nacional 20 de noviembre, Mexico; Enrico Pinotti, Policlinico San Pietro, Italy; Pablo Rodrigues, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Carlos Domingo-del Pozo, Hospital Dr. Peset, Spain; Dimitrios Magouliotis, University of Thessaly, Greece; Aldwin Ong, The Medical City, Philippines; Achilleas Ntinas, European Interbalkan Medical Center, Greece; Felipe Alconchel, Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Spain; Víctor Molina, Hospital de la Santa Creu i Sant Pau, Spain; Oleksandr Kvasivka, National cancer institute, Ukraine; Seren Rossi, Ospedale Ca'Foncello, Italy; Mickael Lesurtel, Beaujon Hospital, France; Rene Adam, Paul Brousse Hospital, France.

Publisher Copyright:
© 2023 International Hepato-Pancreato-Biliary Association Inc.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.hpb.2023.01.003Licence: Unspecified

Cite this

Ghazanfar, M. A., Abdelhamid, A., Aldreghetti, L., Sturesson, C., Takemura, N., Truant, S., Fiorentini, G., Teh, C., Alikhanov, R., Ahmed, I., Hammond, J., Ferrero, A., Silva, M., Pawlik, T., Jones, R., & Bekheit, M. (2023). The dilemma of the disappearing colorectal liver metastases: defining international trends in management. HPB, 25(4), 446-453. https://doi.org/10.1016/j.hpb.2023.01.003

Ghazanfar, MA, Abdelhamid, A, Aldreghetti, L, Sturesson, C, Takemura, N, Truant, S, Fiorentini, G, Teh, C, Alikhanov, R, Ahmed, I, Hammond, J, Ferrero, A, Silva, M, Pawlik, T, Jones, R & Bekheit, M 2023, 'The dilemma of the disappearing colorectal liver metastases: defining international trends in management', HPB, vol. 25, no. 4, pp. 446-453. https://doi.org/10.1016/j.hpb.2023.01.003

@article{9cf37b98465e45b38c88f9ca85d8bc38,

title = "The dilemma of the disappearing colorectal liver metastases: defining international trends in management",

abstract = "OBJECTIVE: This survey sought to appraise the degree of consistency in the management of disappeared colorectal liver metastases (dCRLM) among liver surgeons in different countries.BACKGROUND: Colorectal liver metastases (CRLM) account for half of the deaths secondary to colorectal cancer. Due to the high utilization of chemotherapy before surgery, some or all CRLM can disappear (dCRLM) but management of dCRLMs remains unclear.METHODS: Seven simulated scenarios of dCRLM were presented to experienced liver surgeons using an online platform. Treatment decisions were submitted and analysed using the multi-rater kappa method. The effect of the experience, complexity of scenarios, and location and number of dCRLM on treatment decision were analysed.RESULTS: Sixty-seven liver surgeons from 25 countries completed the survey. There was no agreement about the therapeutic strategies of dCRLM in all scenarios (kappa 0.12, IQR 0.20-0.32). In scenarios with lower difficulty scores, surgeons tended to offer surgical resection for dCRLM alongside the visible CRLM (vCRLM), however, with poor agreement (kappa 0.32, IQR 0.19-0.51). No agreement was seen for clinical scenario in which all CRLM lesions disappeared (kappa 0.20).CONCLUSION: There are clear inconsistencies in the management decisions of dCRLM. Better evidence is required to define optimal management strategies.",

author = "Ghazanfar, {Mudassar A} and Amir Abdelhamid and Luca Aldreghetti and Christian Sturesson and Nobuyuki Takemura and Stephanie Truant and Guido Fiorentini and Catherine Teh and Ruslan Alikhanov and Irfan Ahmed and John Hammond and Alessandro Ferrero and Michael Silva and Timothy Pawlik and Robert Jones and Mohamed Bekheit",

note = "Funding Information: The authors acknowledge the International Hepato-Pancreato-Biliary Association (IHPBA) for endorsement of the survey. The authors acknowledge the following survey participants:, Enrico Pinotti, Policlinico San Pietro, Italy; Maurizio Romano, General Surgery, Italy; Mar{\'i}a Jes{\'u}s Castro Santiago Castro, Hospital Universitario Puerta del Mar. Spain; Mauro Montuori, Policlinico San Pietro, Italy; Dimitrios Magouliotis, University of Thessaly, Greece; Felipe Alconchel, Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Spain; Pablo Rodrigues, Universidade Federal de Ci{\^e}ncias da Sa{\'u}de de Porto Alegre, Brazil; Mario Giuffrida, Parma University Hospital, Italy; Carlos Florez Zorrilla, Centro Medico Nacional 20 de noviembre, Mexico; Amine Benkabbou, Institut national d'oncologie, Morocco; Adianto Nugroho, RSUP Fatmawati, Indonesia; Jonathan Koea, North Shore Hospital, New Zealand; Semra Demirli Atici, University of Health Sciences Tepecik Training and Research Hospital, Turkey; Gabriella Capolupo, Fondazione Policlinico Campus Bio Medico of Rome, Italy; Achilleas Ntinas, European Interbalkan Medical Center, Greece; Guido Fiorentini, Mayo Clinic, United States; Marcello Di Martino, A.O.R.N. Cardarelli, Italy; Francesco Fleres, ASST Valtellina e Alto Lario, Sondrio Hospital, Italy; Marco Serodio, Coimbra's University Hospital, Portugal; Gabriella Capolupo, Fondazione policlinico campus bio medico of Rome, Italy; Asma Sultana, East Lancashire Teaching Hospitals NHS Trust, United Kingdom; Asad Choudhry, SUNY Upstate Medical University, United States; Carlos Domingo-del Pozo, Hospital Dr. Peset, Spain; Amir Abdelhamid, Aberdeen Royal Infirmary, United Kingdom; Sanket Srinivasa, North Shore Hospital, New Zealand; Cornelis Verhoef, Erasmus MC Cancer Institute, Netherlands; Amine Benkabbou, Institut national d'oncologie, CHU Ibn Sina, Morocco; Rafael Garcia, Santa Casa do Par{\'a}, Brazil; Gabriella Capolupo, Fondazione Policlinico campus bio medico of Rome, Italy; Filippo Carannante, Fondazione Policlinico Campus Bio-Medico of Rome, Italy; Frederik Berrevoet, Ghent University Hospital, Belgium; Raffaele Galleano, Ospedale San Paolo, Italy; Carlos Florez-Zorrilla, Centro Medico Nacional 20 de noviembre, Mexico; Enrico Pinotti, Policlinico San Pietro, Italy; Pablo Rodrigues, Universidade Federal de Ci{\^e}ncias da Sa{\'u}de de Porto Alegre, Brazil; Carlos Domingo-del Pozo, Hospital Dr. Peset, Spain; Dimitrios Magouliotis, University of Thessaly, Greece; Aldwin Ong, The Medical City, Philippines; Achilleas Ntinas, European Interbalkan Medical Center, Greece; Felipe Alconchel, Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Spain; V{\'i}ctor Molina, Hospital de la Santa Creu i Sant Pau, Spain; Oleksandr Kvasivka, National cancer institute, Ukraine; Seren Rossi, Ospedale Ca'Foncello, Italy; Mickael Lesurtel, Beaujon Hospital, France; Rene Adam, Paul Brousse Hospital, France. Publisher Copyright: {\textcopyright} 2023 International Hepato-Pancreato-Biliary Association Inc.",

year = "2023",

month = apr,

doi = "10.1016/j.hpb.2023.01.003",

language = "English",

volume = "25",

pages = "446--453",

journal = "HPB",

issn = "1365-182X",

publisher = "John Wiley and Sons Inc.",

number = "4",

}

TY - JOUR

T1 - The dilemma of the disappearing colorectal liver metastases

T2 - defining international trends in management

AU - Ghazanfar, Mudassar A

AU - Abdelhamid, Amir

AU - Aldreghetti, Luca

AU - Sturesson, Christian

AU - Takemura, Nobuyuki

AU - Truant, Stephanie

AU - Fiorentini, Guido

AU - Teh, Catherine

AU - Alikhanov, Ruslan

AU - Ahmed, Irfan

AU - Hammond, John

AU - Ferrero, Alessandro

AU - Silva, Michael

AU - Pawlik, Timothy

AU - Jones, Robert

AU - Bekheit, Mohamed

N1 - Funding Information: The authors acknowledge the International Hepato-Pancreato-Biliary Association (IHPBA) for endorsement of the survey. The authors acknowledge the following survey participants:, Enrico Pinotti, Policlinico San Pietro, Italy; Maurizio Romano, General Surgery, Italy; María Jesús Castro Santiago Castro, Hospital Universitario Puerta del Mar. Spain; Mauro Montuori, Policlinico San Pietro, Italy; Dimitrios Magouliotis, University of Thessaly, Greece; Felipe Alconchel, Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Spain; Pablo Rodrigues, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Mario Giuffrida, Parma University Hospital, Italy; Carlos Florez Zorrilla, Centro Medico Nacional 20 de noviembre, Mexico; Amine Benkabbou, Institut national d'oncologie, Morocco; Adianto Nugroho, RSUP Fatmawati, Indonesia; Jonathan Koea, North Shore Hospital, New Zealand; Semra Demirli Atici, University of Health Sciences Tepecik Training and Research Hospital, Turkey; Gabriella Capolupo, Fondazione Policlinico Campus Bio Medico of Rome, Italy; Achilleas Ntinas, European Interbalkan Medical Center, Greece; Guido Fiorentini, Mayo Clinic, United States; Marcello Di Martino, A.O.R.N. Cardarelli, Italy; Francesco Fleres, ASST Valtellina e Alto Lario, Sondrio Hospital, Italy; Marco Serodio, Coimbra's University Hospital, Portugal; Gabriella Capolupo, Fondazione policlinico campus bio medico of Rome, Italy; Asma Sultana, East Lancashire Teaching Hospitals NHS Trust, United Kingdom; Asad Choudhry, SUNY Upstate Medical University, United States; Carlos Domingo-del Pozo, Hospital Dr. Peset, Spain; Amir Abdelhamid, Aberdeen Royal Infirmary, United Kingdom; Sanket Srinivasa, North Shore Hospital, New Zealand; Cornelis Verhoef, Erasmus MC Cancer Institute, Netherlands; Amine Benkabbou, Institut national d'oncologie, CHU Ibn Sina, Morocco; Rafael Garcia, Santa Casa do Pará, Brazil; Gabriella Capolupo, Fondazione Policlinico campus bio medico of Rome, Italy; Filippo Carannante, Fondazione Policlinico Campus Bio-Medico of Rome, Italy; Frederik Berrevoet, Ghent University Hospital, Belgium; Raffaele Galleano, Ospedale San Paolo, Italy; Carlos Florez-Zorrilla, Centro Medico Nacional 20 de noviembre, Mexico; Enrico Pinotti, Policlinico San Pietro, Italy; Pablo Rodrigues, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Carlos Domingo-del Pozo, Hospital Dr. Peset, Spain; Dimitrios Magouliotis, University of Thessaly, Greece; Aldwin Ong, The Medical City, Philippines; Achilleas Ntinas, European Interbalkan Medical Center, Greece; Felipe Alconchel, Virgen de la Arrixaca University Hospital (IMIB-Arrixaca), Spain; Víctor Molina, Hospital de la Santa Creu i Sant Pau, Spain; Oleksandr Kvasivka, National cancer institute, Ukraine; Seren Rossi, Ospedale Ca'Foncello, Italy; Mickael Lesurtel, Beaujon Hospital, France; Rene Adam, Paul Brousse Hospital, France. Publisher Copyright: © 2023 International Hepato-Pancreato-Biliary Association Inc.

PY - 2023/4

Y1 - 2023/4

N2 - OBJECTIVE: This survey sought to appraise the degree of consistency in the management of disappeared colorectal liver metastases (dCRLM) among liver surgeons in different countries.BACKGROUND: Colorectal liver metastases (CRLM) account for half of the deaths secondary to colorectal cancer. Due to the high utilization of chemotherapy before surgery, some or all CRLM can disappear (dCRLM) but management of dCRLMs remains unclear.METHODS: Seven simulated scenarios of dCRLM were presented to experienced liver surgeons using an online platform. Treatment decisions were submitted and analysed using the multi-rater kappa method. The effect of the experience, complexity of scenarios, and location and number of dCRLM on treatment decision were analysed.RESULTS: Sixty-seven liver surgeons from 25 countries completed the survey. There was no agreement about the therapeutic strategies of dCRLM in all scenarios (kappa 0.12, IQR 0.20-0.32). In scenarios with lower difficulty scores, surgeons tended to offer surgical resection for dCRLM alongside the visible CRLM (vCRLM), however, with poor agreement (kappa 0.32, IQR 0.19-0.51). No agreement was seen for clinical scenario in which all CRLM lesions disappeared (kappa 0.20).CONCLUSION: There are clear inconsistencies in the management decisions of dCRLM. Better evidence is required to define optimal management strategies.

AB - OBJECTIVE: This survey sought to appraise the degree of consistency in the management of disappeared colorectal liver metastases (dCRLM) among liver surgeons in different countries.BACKGROUND: Colorectal liver metastases (CRLM) account for half of the deaths secondary to colorectal cancer. Due to the high utilization of chemotherapy before surgery, some or all CRLM can disappear (dCRLM) but management of dCRLMs remains unclear.METHODS: Seven simulated scenarios of dCRLM were presented to experienced liver surgeons using an online platform. Treatment decisions were submitted and analysed using the multi-rater kappa method. The effect of the experience, complexity of scenarios, and location and number of dCRLM on treatment decision were analysed.RESULTS: Sixty-seven liver surgeons from 25 countries completed the survey. There was no agreement about the therapeutic strategies of dCRLM in all scenarios (kappa 0.12, IQR 0.20-0.32). In scenarios with lower difficulty scores, surgeons tended to offer surgical resection for dCRLM alongside the visible CRLM (vCRLM), however, with poor agreement (kappa 0.32, IQR 0.19-0.51). No agreement was seen for clinical scenario in which all CRLM lesions disappeared (kappa 0.20).CONCLUSION: There are clear inconsistencies in the management decisions of dCRLM. Better evidence is required to define optimal management strategies.

UR - http://www.scopus.com/inward/record.url?scp=85148713540&partnerID=8YFLogxK

U2 - 10.1016/j.hpb.2023.01.003

DO - 10.1016/j.hpb.2023.01.003

M3 - Article

C2 - 36775699

SN - 1365-182X

VL - 25

SP - 446

EP - 453

JO - HPB

JF - HPB

IS - 4

ER -

The dilemma of the disappearing colorectal liver metastases: defining international trends in management

Abstract

Bibliographical note

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this