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Multicenter Study
. 2020 Nov;272(5):715-722.
doi: 10.1097/SLA.0000000000004331.

Choices of Therapeutic Strategies for Colorectal Liver Metastases Among Expert Liver Surgeons: A Throw of the Dice?

Povilas Ignatavicius  1 , Christian E Oberkofler  1 , William C Chapman  2 , Ronald P DeMatteo  3 , Bryan M Clary  4 , Michael I D'Angelica  5 , Kenneth K Tanabe  6 , Johnny C Hong  7 , Thomas A Aloia  8 , Timothy M Pawlik  9 , Roberto Hernandez-Alejandro  10 , Shimul A Shah  11 , Jean-Nicolas Vauthey  8 , Guido Torzilli  12 , Hauke Lang  13 , Pål-Dag Line  14 , Olivier Soubrane  15 , Hugo Pinto-Marques  16 , Ricardo Robles-Campos  17 , Karim Boudjema  18 , Peter Lodge  19 , René Adam  20 , Christian Toso  21 , Alejandro Serrablo  22 , Luca Aldrighetti  23 , Michelle L DeOliveira  1 , Philipp Dutkowski  1 , Henrik Petrowsky  1 , Michael Linecker  1 , Cäcilia S Reiner  24 , Julia Braun  25 , Ruslan Alikhanov  26 , Giedrius Barauskas  27 , Albert C Y Chan  28 , Jiahong Dong  29 , Norihiro Kokudo  30 , Masakazu Yamamoto  31 , Koo Jeong Kang  32 , Yuman Fong  33 , Mohamed Rela  34 , Xabier De Aretxabala  35 , Eduardo De Santibañes  36 , Miguel Ángel Mercado  37 , Oscar C Andriani  38 , Orlando Jorge M Torres  39 , Antonio D Pinna  40 , Pierre-Alain Clavien  1
Affiliations
Multicenter Study

Choices of Therapeutic Strategies for Colorectal Liver Metastases Among Expert Liver Surgeons: A Throw of the Dice?

Povilas Ignatavicius et al. Ann Surg. 2020 Nov.

Abstract

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.

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References

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    1. Clavien P-A, Oberkofler CE, Raptis DA, et al. What is critical for liver surgery and partial liver transplantation: Size or quality? Hepatology 2010; 52:715–729.
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