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Treating Patients with Colon Cancer Liver Metastasis: A Nationwide Analysis of Therapeutic Decision Making

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

Abstract

Background

Criteria for resectability of colon cancer liver metastases (CLM) are evolving, yet little is known about how physicians choose a therapeutic strategy for potentially resectable CLM.

Methods

Physicians completed a national Web-based survey that consisted of varied CLM conjoint tasks. Respondents chose among three treatment strategies: immediate liver resection (LR), preoperative chemotherapy followed by surgery (C → LR), or palliative chemotherapy (PC). Data were analyzed by multinomial logistic regression, yielding odds ratios (OR).

Results

Of 219 respondents, 79 % practiced at academic centers and 63 % were in practice ≥10 years. Median number of cases evaluated was four per month. Surgical training varied: 51 % surgical oncology, 44 % hepato-pancreato-biliary/transplantation, 5 % no fellowship. Although each factor affected the choice of CLM therapy, the relative effect differed. Hilar lymph node disease predicted a strong aversion to LR with surgeons more likely to choose C → LR (OR 8.92) or PC (OR 49.9). Solitary lung metastasis also deterred choice of LR, with respondents favoring C → LR (OR 4.43) or PC (OR 6.97). After controlling for clinical factors, surgeons with more years in practice were more likely to choose PC over C → LR (OR 1.94) (P = 0.005). Surgical oncology-trained surgeons were more likely than hepatobiliary/transplant-trained surgeons to choose C → LR (OR 2.53) or PC (OR 4.15) (P < 0.001).

Conclusions

This is the first nationwide study to define the relative impact of key clinical factors on choice of therapy for CLM. Although clinical factors influence choice of therapy, surgical subspeciality and physician experience are also important determinants of care.

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Authors and Affiliations

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

    Hari Nathan MD, PhD, Richard D. Schulick MD, Barish H. Edil MD, Christopher L. Wolfgang MD, PhD, Michael A. Choti MD & Timothy M. Pawlik MD, MPH, PhD

  2. Department of Health Policy & Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    John F. Bridges PhD

  3. Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    David P. Cosgrove MD, Luis A. Diaz Jr MD & Daniel A. Laheru MD

  4. Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Joseph M. Herman MD, MSc

Authors
  1. Hari Nathan MD, PhD
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  2. John F. Bridges PhD
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  3. David P. Cosgrove MD
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  4. Luis A. Diaz Jr MD
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  5. Daniel A. Laheru MD
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  6. Joseph M. Herman MD, MSc
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  7. Richard D. Schulick MD
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  8. Barish H. Edil MD
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  9. Christopher L. Wolfgang MD, PhD
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  10. Michael A. Choti MD
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  11. Timothy M. Pawlik MD, MPH, PhD
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Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD.

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Nathan, H., Bridges, J.F., Cosgrove, D.P. et al. Treating Patients with Colon Cancer Liver Metastasis: A Nationwide Analysis of Therapeutic Decision Making. Ann Surg Oncol 19, 3668–3676 (2012). https://doi.org/10.1245/s10434-012-2564-3

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  • DOI: https://doi.org/10.1245/s10434-012-2564-3

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