TY - JOUR
T1 - Choices of Therapeutic Strategies for Colorectal Liver Metastases Among Expert Liver Surgeons
T2 - A Throw of the Dice?
AU - Ignatavicius, Povilas
AU - Oberkofler, Christian E.
AU - Chapman, William C.
AU - DeMatteo, Ronald P.
AU - Clary, Bryan M.
AU - D'Angelica, Michael I.
AU - Tanabe, Kenneth K.
AU - Hong, Johnny C.
AU - Aloia, Thomas A.
AU - Pawlik, Timothy M.
AU - Hernandez-Alejandro, Roberto
AU - Shah, Shimul A.
AU - Vauthey, Jean Nicolas
AU - Torzilli, Guido
AU - Lang, Hauke
AU - Line, Pål Dag
AU - Soubrane, Olivier
AU - Pinto-Marques, Hugo
AU - Robles-Campos, Ricardo
AU - Boudjema, Karim
AU - Lodge, Peter
AU - Adam, René
AU - Toso, Christian
AU - Serrablo, Alejandro
AU - Aldrighetti, Luca
AU - DeOliveira, Michelle L.
AU - Dutkowski, Philipp
AU - Petrowsky, Henrik
AU - Linecker, Michael
AU - Reiner, Cäcilia S.
AU - Braun, Julia
AU - Alikhanov, Ruslan
AU - Barauskas, Giedrius
AU - Chan, Albert C.Y.
AU - Dong, Jiahong
AU - Kokudo, Norihiro
AU - Yamamoto, Masakazu
AU - Kang, Koo Jeong
AU - Fong, Yuman
AU - Rela, Mohamed
AU - De Aretxabala, Xabier
AU - De Santibañes, Eduardo
AU - Mercado, Miguel Ángel
AU - Andriani, Oscar C.
AU - Torres, Orlando Jorge M.
AU - Pinna, Antonio D.
AU - Clavien, Pierre Alain
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - 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.
AB - 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.
KW - colorectal liver metastasis
KW - expert liver surgeons
KW - surgery
KW - variability of treatment strategies
UR - http://www.scopus.com/inward/record.url?scp=85088030668&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000004331
DO - 10.1097/SLA.0000000000004331
M3 - Article
C2 - 32833764
AN - SCOPUS:85088030668
SN - 0003-4932
VL - 272
SP - 715
EP - 722
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -