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Failure to Cure Patients with Colorectal Liver Metastases: The Impact of the Liver Surgeon

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

A Correction to this article was published on 18 May 2021

This article has been updated

Abstract

Background

Lack of a liver surgeon (LS) may lead to failure to cure in patients with possibly resectable colorectal liver metastases (CRLM). This study aims to quantify the failure-to-cure rate due to noninclusion of an LS.

Patients and Methods

All patients who underwent chemotherapy with palliative intent for CRLM at a community oncology network between 2010 and 2018 were identified from a prospectively maintained cancer registry. Two LS blinded to patient management and outcome reviewed pretreatment imaging and assigned each scan a newly developed resectability score. Nominal group technique and independent scores were combined to determine probability of curative-intent resection. Interobserver agreement was calculated using κ testing.

Results

This study included 72 palliative CRLM patients. Demographic factors were: 44 (59%) male, median age 68 years (range 36–94 years), 23 (32%) rectal primary, 24 (33%) receiving oxaliplatin-based chemotherapy. Of the 72 patients with CRLM, 6 had left-sided metastases only. The median number of CRLM was 6 (1–8). Agreement on resectability was achieved in 32 (44%) patients for the entire cohort and 17 (54%) in patients without extrahepatic disease. A lower median number of CRLM was found in the group considered to be resectable by the two LS (2 versus 8; p = 0.001). Substantial agreement was found between liver surgeons in the group of patients without extrahepatic disease (κ = 0.9043).

Conclusions

Over 44% of patients who were assigned palliative chemotherapy at tumor boards without an LS were considered potentially resectable upon independent LS review.

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Acknowledgment

The authors thank Daria James, BA, CTR for her valuable assistance in project planning and data accrual management.

Funding

This research did not receive any specific funding from agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, St. Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA, USA

    Eduardo A. Vega MD, Omid Salehi MD, Edward-Michael Dussom MD, Jana Simonds MD, Deborah Schnipper MD & Claudius Conrad MD, PHD, FACS, FSSO

  2. IOSUD Titu Maiorescu University of Bucharest, Medical Doctoral School, Tulcea Emergency Hospital, Bucharest, Romania

    Diana Nicolaescu MD

  3. Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Sylvia V. Alarcon MD & Olga Kozyreva MD

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  1. Eduardo A. Vega MD
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Correspondence to Claudius Conrad MD, PHD, FACS, FSSO.

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Claudius Conrad – Consultant: Fuji, Integra, Olympus.

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The original online version of this article has been revised: Diana Nicolaescu’s last name was corrected.

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Vega, E.A., Salehi, O., Nicolaescu, D. et al. Failure to Cure Patients with Colorectal Liver Metastases: The Impact of the Liver Surgeon. Ann Surg Oncol 28, 7698–7706 (2021). https://doi.org/10.1245/s10434-021-10030-0

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  • DOI: https://doi.org/10.1245/s10434-021-10030-0

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