Management strategies for patients with advanced rectal cancer and liver metastases using modified Delphi methodology: results from the PelvEx Collaborative

PelvEx Collaborative

Collaborators

PelvEx Collaborative:
Kelly Me, Aalbers Agj, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angenete E, Antoniou A, Auer R, Austin Kk, Aziz O, Baker Rp, Bali M, Baseckas G, Bebington B, Bednarski Bk, Beets Gl, Berg Pl, Beynon J, Biondo S, Boyle K, Bordeianou L, Bremers Ab, Brunner M, Buchwald P, Bui A, Burgess A, Burger Jwa, Burling D, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Chan Kkl, Chang Gj, Chew Mh, Chong P, Christensen Hk, Clouston H, Codd M, Collins D, Colquhoun Aj, Corr A, Coscia M, Coyne Pe, Creavin B, Croner Rs, Damjanovic L, Daniels Ir, Davies M, Davies Rj, Delaney Cp, de Wilt Jhw, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois Ej, Duff M, Eglinton T, Enrique-Navascues Jm, Espin-Basany E, Evans Md, Fearnhead Ns, Flatmark K, Fleming F, Frizelle Fa, Gallego Ma, Garcia-Granero E, Garcia-Sabrido Jl, Gentilini L, George Ml, Ghouti L, Giner F, Ginther N, Glynn R, Golda T, Griffiths B, Harris D A, Hagemans Jaw, Hanchanale V, Harji Dp, Helewa Rm, Hellawell G, Heriot Ag, Hochman D, Hohenberger W, Holm T, Hompes R, Jenkins Jt, Kaffenberger S, Kandaswamy Gv, Kapur S, Kanemitsu Y, Kelley Sr, Keller Ds, Khan Ms, Kiran Rp, Kim H, Kim Hj, Koh Ce, Kok Nfm, Kokelaar R, Kontovounisios C, Kristensen H Ø, Kroon Hm, Kusters M, Lago V, Larsen Sg, Larson Dw, Law Wl, Laurberg S, Lee Pj, Limbert M, Lydrup Ml, Lyons A, Lynch Ac, Mantyh C, Mathis Kl, Margues Cfs, Martling A, Meijerink Wjhj, Merkel S, Mehta Am, McArthur Dr, McDermott Fd, McGrath Js, Malde S, Mirnezami A, Monson Jrt, Morton Jr, Mullaney Tg, Negoi I, Neto Jwm, Nguyen B, Nielsen Mb, Nieuwenhuijzen Gap, Nilsson Pj, O'Connell Pr, O'Dwyer St, Palmer G, Pappou E, Park J, Patsouras D, Pellino G, Peterson Ac, Poggioli G, Proud D, Quinn M, Quyn A, Radwan Rw, Rasheed S, Rasmussen Pc, Regenbogen Se, Renehan A, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten Hjt, Ryan Éj, Safar B, Sagar Pm, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas Amp, Schwarzkopf E, Scripcariu V, Selvasekar C, Shaikh I, Shida D, Simpson A, Smart Nj, Smart P, Smith Jj, Solbakken Am, Solomon Mj, Sørensen Mm, Steele Sr, Steffens D, Stitzenberg K, Stocchi L, Stylianides Na, Sumrien H, Sutton Pa, Swartking T, Taylor C, Tekkis Pp, Teras J, Thurairaja R, Toh El, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech Jj, Turner Wh, Tuynman Jb, van Ramshorst Gh, van Zoggel D, Vasquez-Jimenez W, Verhoef C, Vizzielli G, Voogt Elk, Uehara K, Wakeman C, Warrier S, Wasmuth Hh, Weber K, Weiser Mr, Wheeler Jmd, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo Rn, Winter Dc

PMID: 32043753
DOI: 10.1111/codi.15007

Management strategies for patients with advanced rectal cancer and liver metastases using modified Delphi methodology: results from the PelvEx Collaborative

PelvEx Collaborative. Colorectal Dis. 2020 Sep.

. 2020 Sep;22(9):1184-1188.

doi: 10.1111/codi.15007. Epub 2020 Mar 2.

Author

PelvEx Collaborative

Collaborators

PelvEx Collaborative:
Kelly Me, Aalbers Agj, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angenete E, Antoniou A, Auer R, Austin Kk, Aziz O, Baker Rp, Bali M, Baseckas G, Bebington B, Bednarski Bk, Beets Gl, Berg Pl, Beynon J, Biondo S, Boyle K, Bordeianou L, Bremers Ab, Brunner M, Buchwald P, Bui A, Burgess A, Burger Jwa, Burling D, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Chan Kkl, Chang Gj, Chew Mh, Chong P, Christensen Hk, Clouston H, Codd M, Collins D, Colquhoun Aj, Corr A, Coscia M, Coyne Pe, Creavin B, Croner Rs, Damjanovic L, Daniels Ir, Davies M, Davies Rj, Delaney Cp, de Wilt Jhw, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois Ej, Duff M, Eglinton T, Enrique-Navascues Jm, Espin-Basany E, Evans Md, Fearnhead Ns, Flatmark K, Fleming F, Frizelle Fa, Gallego Ma, Garcia-Granero E, Garcia-Sabrido Jl, Gentilini L, George Ml, Ghouti L, Giner F, Ginther N, Glynn R, Golda T, Griffiths B, Harris D A, Hagemans Jaw, Hanchanale V, Harji Dp, Helewa Rm, Hellawell G, Heriot Ag, Hochman D, Hohenberger W, Holm T, Hompes R, Jenkins Jt, Kaffenberger S, Kandaswamy Gv, Kapur S, Kanemitsu Y, Kelley Sr, Keller Ds, Khan Ms, Kiran Rp, Kim H, Kim Hj, Koh Ce, Kok Nfm, Kokelaar R, Kontovounisios C, Kristensen H Ø, Kroon Hm, Kusters M, Lago V, Larsen Sg, Larson Dw, Law Wl, Laurberg S, Lee Pj, Limbert M, Lydrup Ml, Lyons A, Lynch Ac, Mantyh C, Mathis Kl, Margues Cfs, Martling A, Meijerink Wjhj, Merkel S, Mehta Am, McArthur Dr, McDermott Fd, McGrath Js, Malde S, Mirnezami A, Monson Jrt, Morton Jr, Mullaney Tg, Negoi I, Neto Jwm, Nguyen B, Nielsen Mb, Nieuwenhuijzen Gap, Nilsson Pj, O'Connell Pr, O'Dwyer St, Palmer G, Pappou E, Park J, Patsouras D, Pellino G, Peterson Ac, Poggioli G, Proud D, Quinn M, Quyn A, Radwan Rw, Rasheed S, Rasmussen Pc, Regenbogen Se, Renehan A, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten Hjt, Ryan Éj, Safar B, Sagar Pm, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas Amp, Schwarzkopf E, Scripcariu V, Selvasekar C, Shaikh I, Shida D, Simpson A, Smart Nj, Smart P, Smith Jj, Solbakken Am, Solomon Mj, Sørensen Mm, Steele Sr, Steffens D, Stitzenberg K, Stocchi L, Stylianides Na, Sumrien H, Sutton Pa, Swartking T, Taylor C, Tekkis Pp, Teras J, Thurairaja R, Toh El, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech Jj, Turner Wh, Tuynman Jb, van Ramshorst Gh, van Zoggel D, Vasquez-Jimenez W, Verhoef C, Vizzielli G, Voogt Elk, Uehara K, Wakeman C, Warrier S, Wasmuth Hh, Weber K, Weiser Mr, Wheeler Jmd, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo Rn, Winter Dc

PMID: 32043753
DOI: 10.1111/codi.15007

Abstract

Aim: A total of 15-20% of patients with rectal cancer have liver metastases on presentation. The management of these patients is controversial. Heterogeneity in management strategies is considerable, with management often being dependent on local resources and available expertise.

Method: Members of the PelvEx Collaborative were invited to participate in the generation of a consensus statement on the optimal management of patients with advanced rectal cancer with liver involvement. Fifteen statements were created for topical discussion on diagnostic and management issues. Panellists were asked to vote on statements and anonymous feedback was given. A collaborative meeting was used to discuss any nuances and clarify any obscurity. Consensus was considered when > 85% agreement on a statement was achieved.

Results: A total of 135 participants were involved in the final round of the Delphi questionnaire. Nine of the 15 statements reached consensus regarding the management of patients with advanced rectal cancer and oligometastatic liver disease. Routine use of liver MRI was not recommended for patients with locally advanced rectal cancer, unless there was concern for metastatic disease on initial computed tomography staging scan. Induction chemotherapy was advocated as first-line treatment in those with synchronous liver metastases in locally advanced rectal cancer. In the presence of symptomatic primary disease, a diverting stoma may be required to facilitate induction chemotherapy. Overall, only one-quarter of the panellists would consider simultaneous pelvic exenteration and liver resection.

Conclusion: This Delphi process highlights the diverse treatment of advanced rectal cancer with liver metastases and provides recommendations from an experienced international group regarding the multidisciplinary management approach.

Keywords: Rectal cancer; international collaboration; liver metastasis; surgical outcomes; survival outcomes.

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References

1. van der Geest LG, Lam-Boer J, Koopman M, Verhoef C, Elferink MA, de Wilt JH. Nationwide trends in incidence, treatment and survival of colorectal cancer patients with synchronous metastases. Clin Exp Metastasis 2015; 32: 457-65.
1. Choti MA, Sitzmann JV, Tiburi MF et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 2002; 235: 759-66.
1. Nielsen M, Rasmussen P, Lindegaard J, Laurberg S. A 10-year experience of total pelvic exenteration for primary advanced and locally recurrent rectal cancer based on a prospective database. Colorectal Dis 2012; 14: 1076-83.
1. PelvEx Collaborative. Simultaneous pelvic exenteration and liver resection for rectal cancer with synchronous oligometastatic disease: results from the PelvEx Collaborative; 2019; In Press.
1. Mantke R, Schimdt U, Wolff S, Kube R, Lippert H. Incidence of synchronous liver metastases in patients with colorectal cancer in relationship to clinic-pathologic characteristics. Results of a German prospective multicentre observational study. Eur J Surg Oncol 2012; 38: 259-65.

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Management strategies for patients with advanced rectal cancer and liver metastases using modified Delphi methodology: results from the PelvEx Collaborative

Collaborators

Management strategies for patients with advanced rectal cancer and liver metastases using modified Delphi methodology: results from the PelvEx Collaborative

Author

Collaborators

Abstract

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical