Choices of Therapeutic Strategies for Colorectal Liver Metastases Among Expert Liver Surgeons: A Throw of the Dice?
Por:
Ignatavicius P., Oberkofler C.E., Chapman W.C., DeMatteo R.P., Clary B.M., D'Angelica M.I., Tanabe K.K., Hong J.C., Aloia T.A., Pawlik T.M., Hernandez-Alejandro R., Shah S.A., Vauthey J.-N., Torzilli G., Lang H., Line P.-D., Soubrane O., Pinto-Marques H., Robles-Campos R., Boudjema K., Lodge P., Adam R., Toso C., Serrablo A., Aldrighetti L., DeOliveira M.L., Dutkowski P., Petrowsky H., Linecker M., Reiner C.S., Braun J., Alikhanov R., Barauskas G., Chan A.C.Y., Dong J., Kokudo N., Yamamoto M., Kang K.J., Fong Y., Rela M., De Aretxabala X., De Santibañes E., Mercado M.Á., Andriani O.C., Torres O.J.M., Pinna A.D., Clavien P.-A.
Publicada:
1 ene 2020
Categoría:
Surgery
Resumen:
OBJECTIVE: To test the degree of agreement in selecting therapeutic options for patients suffering from colorectal liver metastasis (CRLM) among surgical experts around the globe. SUMMARY/BACKGROUND: Only few areas in medicine have seen so many novel therapeutic options over the past decades as for liver tumors. Significant variations may therefore exist regarding the choices of treatment, even among experts, which may confuse both the medical community and patients. METHODS: Ten cases of CRLM with different levels of complexity were presented to 43 expert liver surgeons from 23 countries and 4 continents. Experts were defined as experienced surgeons with academic contributions to the field of liver tumors. Experts provided information on their medical education and current practice in liver surgery and transplantation. Using an online platform, they chose their strategy in treating each case from defined multiple choices with added comments. Inter-rater agreement among experts and cases was calculated using free-marginal multirater kappa methodology. A similar, but adjusted survey was presented to 60 general surgeons from Asia, Europe, and North America to test their attitude in treating or referring complex patients to expert centers. RESULTS: Thirty-eight (88%) experts completed the evaluation. Most of them are in leading positions (92%) with a median clinical experience of 25 years. Agreement on therapeutic strategies among them was none to minimal in more than half of the cases with kappa varying from 0.00 to 0.39. Many general surgeons may not refer the complex cases to expert centers, including in Europe, where they also engage in complex liver surgeries. CONCLUSIONS: Considerable inconsistencies of decision-making exist among expert surgeons when choosing a therapeutic strategy for CRLM. This might confuse both patients and referring physicians and indicate that an international high-level consensus statements and widely accepted guidelines are needed.
Filiaciones:
Ignatavicius P.:
Department of Surgery and Transplantation, University Hospital ZurichZurich, Switzerland
Oberkofler C.E.:
Department of Surgery and Transplantation, University Hospital ZurichZurich, Switzerland
Chapman W.C.:
Department of Surgery and Transplantation, Washington University School of MedicineWA
DeMatteo R.P.:
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States
Clary B.M.:
Department of Surgery, University of California at San Diego, San Diego, Mexico
D'Angelica M.I.:
Department of SurgeryNY
Tanabe K.K.:
Department of Surgery, Massachusetts General Hospital, Boston
Hong J.C.:
Department of Surgery and Transplantation, Medical College of WisconsinWI
Aloia T.A.:
Department of Surgery, MD Anderson Cancer Center, Houston
Pawlik T.M.:
Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH
Hernandez-Alejandro R.:
Division of Transplantation and Hepatobiliary Surgery, University of Rochester, NY
Shah S.A.:
Department of Surgery and Transplantation, University of Cincinnati College of Medicine, Cincinnati, United States
Vauthey J.-N.:
Department of Surgery, MD Anderson Cancer Center, Houston
Torzilli G.:
Department of Surgery and Transplantation, Humanitas University Milan, Milan, Italy
Lang H.:
Department of Surgery and Transplantation, University Hospital Mainz, Mainz, Germany
Line P.-D.:
Department of Transplantation Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
Soubrane O.:
Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, France
Pinto-Marques H.:
Department of Surgery and Transplantation, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
Robles-Campos R.:
Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIBMurcia, Spain
Boudjema K.:
Department of Hepatobiliary and Digestive Surgery, Hospital Pontchaillou, University of Rennes 1, Rennes, France
Lodge P.:
Department of Surgery and Transplantation, St. James's University Hospital, Leeds, United Kingdom
Adam R.:
Centre Hepato-Biliaire, Hôpital Paul Brousse, Villejuif, France
Toso C.:
Division of Abdominal Surgery, Geneva University HospitalsGeneva, Switzerland
Serrablo A.:
Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
Aldrighetti L.:
Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy
DeOliveira M.L.:
Department of Surgery and Transplantation, University Hospital ZurichZurich, Switzerland
Dutkowski P.:
Department of Surgery and Transplantation, University Hospital ZurichZurich, Switzerland
Petrowsky H.:
Department of Surgery and Transplantation, University Hospital ZurichZurich, Switzerland
Linecker M.:
Department of Surgery and Transplantation, University Hospital ZurichZurich, Switzerland
Reiner C.S.:
Department of Radiology, University Hospital ZurichZurich, Switzerland
Braun J.:
Epidemiology, Biostatistics and Prevention Institute, University of ZurichZurich, Switzerland
Alikhanov R.:
Department of Surgery and Transplantation, Moscow Clinical Scientific CenterMoscow, Russian Federation
Barauskas G.:
Department of Surgery, Lithuanian University of Health SciencesKaunas, Lithuania
Chan A.C.Y.:
Department of Surgery, University of Hong Kong, Hong Kong
Dong J.:
Department of Surgery and Transplantation, Beijing Tsinghua Changgung HospitalBeijing, China
Kokudo N.:
Department of Surgery, National Center for Global Health and MedicineTokyo, Japan
Yamamoto M.:
Institute of Gastroenterology, Tokyo Women's Medical UniversityTokyo, Japan
Kang K.J.:
Division of HBP Surgery, Department of Surgery, Keimyung University Dong-San Hospital Daegu, South Korea
Fong Y.:
Department of Surgery, City of Hope Medical CenterDuarte, United States
Rela M.:
Department of Surgery and Transplantation, Dr. Rela Institute & Medical Centre Chennai, Chennai, India
De Aretxabala X.:
Department of Surgery and Transplantation, University del DesarrolloSantiago, Chile
De Santibañes E.:
Department of Surgery and Transplantation, Hospital Italiano de Buenos AiresBuenos Aires, Argentina
Mercado M.Á.:
Department of Surgery and Transplantation, Instituto Nacional de Ciencias Medicas y Nutricion, Mexico
Andriani O.C.:
Oncosurgical HPB Surgery of Sanatorio de los Arcos, Swiss Medical GroupBuenos Aires, Argentina
Torres O.J.M.:
Department of hepatopancreatobiliary surgery and transplantation, University of Maranhao, São Luis, Brazil
Pinna A.D.:
Department of Surgery and Transplantation, University of Bologna, Bologna, Italy
Clavien P.-A.:
Department of Surgery and Transplantation, University Hospital ZurichZurich, Switzerland
|