Practice Guideline

. 2021 Jan;28(1):1-25.

doi: 10.1002/jhbp.868. Epub 2020 Dec 12.

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Masakazu Yamamoto¹, Masahiro Yoshida², Junji Furuse³, Keiji Sano⁴, Masayuki Ohtsuka⁵, Shingo Yamashita¹, Toru Beppu⁶, Yukio Iwashita⁷, Keita Wada⁴, Takako Eguchi Nakajima^{8

9}, Katsunori Sakamoto¹⁰, Koichi Hayano¹¹, Yasuhisa Mori¹², Koji Asai¹³, Ryusei Matsuyama¹⁴, Teijiro Hirashita⁷, Taizo Hibi¹⁵, Nozomu Sakai⁵, Tsutomu Tabata¹⁶, Hisato Kawakami¹⁷, Hiroyuki Takeda⁸, Takuro Mizukami⁸, Masato Ozaka¹⁸, Makoto Ueno¹⁹, Yoichi Naito²⁰, Naohiro Okano³, Takayuki Ueno²¹, Susumu Hijioka²², Satoru Shikata²³, Tomohiko Ukai²⁴, Steven Strasberg²⁵, Michael G Sarr²⁶, Palepu Jagannath²⁷, Tsann-Long Hwang²⁸, Ho-Seong Han²⁹, Yoo-Seok Yoon²⁹, Hee Jung Wang³⁰, Shao-Ciao Luo³¹, René Adam³², Mariano Gimenez^{33

34}, Olivier Scatton³⁵, Do-Youn Oh³⁶, Tadahiro Takada⁴

Affiliations

¹ Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
² Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Ichikawa, Japan.
³ Department of Medical Oncology, Kyorin University Faculty of Medicine, Mitaka, Japan.
⁴ Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
⁵ Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
⁶ Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan.
⁷ Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
⁸ Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan.
⁹ Kyoto Innovation Center for Next Generation Clinical Trials and iPS Cell Therapy, Kyoto University Hospital, Kyoto, Japan.
¹⁰ Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan.
¹¹ Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
¹² Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹³ Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan.
¹⁴ Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokoama, Japan.
¹⁵ Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
¹⁶ Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan.
¹⁷ Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan.
¹⁸ Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
¹⁹ Division of Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan.
²⁰ Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
²¹ Breast Surgical Oncology, Cancer Institute Hospital, Tokyo, Japan.
²² Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan.
²³ Mie Prefectural Ichishi Hospital, Mie, Japan.
²⁴ Division of Public Health, Osaka Institute of Public Health, Higashinari, Japan.
²⁵ Section of HPB Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA.
²⁶ Department of Surgery, Mayo Clinic, Rochester, MN, USA.
²⁷ Lilavati Hospital & SL Raheja Hospital, Mumbai, India.
²⁸ Division of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
²⁹ Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
³⁰ Ajou University School of Medicine, Suwon, Korea.
³¹ Taichung Veterans General Hospital, Taichung, Taiwan.
³² AP HP Paul Brousse Hospital, University Paris Sud, Villejuif, France.
³³ Docencia Asistencia Investigación en Cirugía Invasiva Mínima Foundation, General and Minimally Invasive Surgery, University of Buenos Aires, Viamonte, Argentina.
³⁴ Institute of Image-Guided Surgery, Strasbourg, France.
³⁵ Department of Hepatobiliary Surgery and Liver Transplantation, APHP Pitié-Salpêtrière Hospital, Sorbonne Université, CRSA, Paris, France.
³⁶ Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.

PMID: 33200538
DOI: 10.1002/jhbp.868

Practice Guideline

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Masakazu Yamamoto et al. J Hepatobiliary Pancreat Sci. 2021 Jan.

. 2021 Jan;28(1):1-25.

doi: 10.1002/jhbp.868. Epub 2020 Dec 12.

Authors

Affiliations

¹ Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
² Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Ichikawa, Japan.
³ Department of Medical Oncology, Kyorin University Faculty of Medicine, Mitaka, Japan.
⁴ Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
⁵ Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
⁶ Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan.
⁷ Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
⁸ Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan.
⁹ Kyoto Innovation Center for Next Generation Clinical Trials and iPS Cell Therapy, Kyoto University Hospital, Kyoto, Japan.
¹⁰ Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan.
¹¹ Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
¹² Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹³ Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan.
¹⁴ Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokoama, Japan.
¹⁵ Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
¹⁶ Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan.
¹⁷ Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan.
¹⁸ Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
¹⁹ Division of Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan.
²⁰ Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
²¹ Breast Surgical Oncology, Cancer Institute Hospital, Tokyo, Japan.
²² Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan.
²³ Mie Prefectural Ichishi Hospital, Mie, Japan.
²⁴ Division of Public Health, Osaka Institute of Public Health, Higashinari, Japan.
²⁵ Section of HPB Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA.
²⁶ Department of Surgery, Mayo Clinic, Rochester, MN, USA.
²⁷ Lilavati Hospital & SL Raheja Hospital, Mumbai, India.
²⁸ Division of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
²⁹ Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
³⁰ Ajou University School of Medicine, Suwon, Korea.
³¹ Taichung Veterans General Hospital, Taichung, Taiwan.
³² AP HP Paul Brousse Hospital, University Paris Sud, Villejuif, France.
³³ Docencia Asistencia Investigación en Cirugía Invasiva Mínima Foundation, General and Minimally Invasive Surgery, University of Buenos Aires, Viamonte, Argentina.
³⁴ Institute of Image-Guided Surgery, Strasbourg, France.
³⁵ Department of Hepatobiliary Surgery and Liver Transplantation, APHP Pitié-Salpêtrière Hospital, Sorbonne Université, CRSA, Paris, France.
³⁶ Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.

PMID: 33200538
DOI: 10.1002/jhbp.868

Erratum in

Corrigendum.
[No authors listed] [No authors listed] J Hepatobiliary Pancreat Sci. 2022 Apr;29(4):500. doi: 10.1002/jhbp.923. Epub 2021 Mar 15. J Hepatobiliary Pancreat Sci. 2022. PMID: 35481901 No abstract available.

Abstract

Background: Hepatectomy is standard treatment for colorectal liver metastases; however, it is unclear whether liver metastases from other primary cancers should be resected or not. The Japanese Society of Hepato-Biliary-Pancreatic Surgery therefore created clinical practice guidelines for the management of metastatic liver tumors.

Methods: Eight primary diseases were selected based on the number of hepatectomies performed for each malignancy per year. Clinical questions were structured in the population, intervention, comparison, and outcomes (PICO) format. Systematic reviews were performed, and the strength of recommendations and the level of quality of evidence for each clinical question were discussed and determined. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations.

Results: The eight primary sites were grouped into five categories based on suggested indications for hepatectomy and consensus of the guidelines committee. Fourteen clinical questions were devised, covering five topics: (1) diagnosis, (2) operative treatment, (3) ablation therapy, (4) the eight primary diseases, and (5) systemic therapies. The grade of recommendation was strong for one clinical question and weak for the other 13 clinical questions. The quality of the evidence was moderate for two questions, low for 10, and very low for two. A flowchart was made to summarize the outcomes of the guidelines for the indications of hepatectomy and systemic therapy.

Conclusions: These guidelines were developed to provide useful information based on evidence in the published literature for the clinical management of liver metastases, and they could be helpful for conducting future clinical trials to provide higher-quality evidence.

Keywords: ablation therapy; disappearing liver metastases; hepatectomy; metastatic liver tumors; systemic therapy.

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References

REFERENCES

1. Van Cutsem E, Cervantes A, Adam R, Sobrero A, Van Krieken JH, Aderka D, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016;27:1386-422.
1. Pavel M, O'Toole D, Costa F, Capdevila J, Gross D, Kianmanesh R, et al. ENETS consensus guidelines update for the management of distant metastatic disease of intestinal, pancreatic, bronchial neuroendocrine neoplasms (NEN) and NEN of unknown primary site. Neuroendocrinology. 2016;103:172-85.
1. Sano K, Yamamoto M, Mimura T, Endo I, Nakamori S, Konishi M, et al. Japanese Society of Hepato-Biliary-Pancreatic Surgery. Outcomes of 1,639 hepatectomies for non-colorectal non-neuroendocrine liver metastases: a multicenter analysis. J Hepatobiliary Pancreat Sci. 2018;25:465-75.
1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE Working Group: GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924-6.
1. Andrews J, Guyatt G, Oxman AD, Alderson P, Dahm P, Falck-Ytter Y, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol. 2013;66:719-25.

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Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

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Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

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