title: Evaluating agreement regarding the resectability of colorectal liver metastases: a national case-based survey of hepatic surgeons.
abstract: BACKGROUND
  The resectability of colorectal liver metastases is in part largely based on the surgeon's assessment of cross-sectional imaging. This process, while guided by principles, is subjective. The objective of the present study was to assess agreement between hepatic surgeons regarding the resectability of colorectal liver metastases.
  
  
  METHODS
  Forty-six hepatic surgeons across Canada were invited. A patient with biologically favourable disease was presented after having received neoadjuvant chemotherapy. The scenario was matched with 10 different scrollable abdominal CT scans representing a maximum response after six cycles of chemotherapy. Surgeons were asked to offer an opinion on resectability of liver metastases, and whether they would use adjunct modalities to hepatic resection.
  
  
  RESULTS
  Twenty-six surgeons participated. Twenty responses were complete. The median number of scenarios deemed resectable was 6/10 (range 3-8). Two control scenarios demonstrated perfect agreement. Agreement on resectability was poor for 4/8 test scenarios, of which one scenario demonstrated complete disagreement. Among resectable cases, the pattern of use of adjunct modalities was variable. A median ratio of 0.87 adjunct modality per resectable scenario per surgeon was used (range 0.25-1.75).
  
  
  CONCLUSIONS
  A significant lack of agreement was identified among surgeons on the resectability and use of adjunct modalities in the treatment of colorectal liver metastases.
authors.affiliation: Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ontario, Canada.
authors.forename: Waleed M
authors.initials: WM
authors.lastname: Mohammad
authors.forename: Guillaume
authors.initials: G
authors.lastname: Martel
authors.forename: Richard
authors.initials: R
authors.lastname: Mimeault
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fairfull-Smith
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Auer
authors.forename: Fady K
authors.initials: FK
authors.lastname: Balaa
mesh_terms: D002170:Canada; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D019538:Health Care Surveys; D006498:Hepatectomy / Q000706:statistics & numerical data; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D020360:Neoadjuvant Therapy; D015588:Observer Variation; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed