title: Effect of specialist decision-making on treatment strategies for colorectal liver metastases.
abstract: BACKGROUND
  One hundred and ten patients were treated with palliative chemotherapy, of whom 53 had liver-only disease and had not been reviewed by a specialist liver surgeon. One scan was excluded as all reviewers felt it to be of insufficient quality to assess. Improved surgical technique and better chemotherapeutic manipulation of metastatic disease has increased the number of patients eligible for potentially curative resection of colorectal liver metastases. The rapid evolution in this field suggests that non-specialist decision-making may lead to inappropriate management. This study aimed to assess the management of colorectal liver metastases by non-liver surgeons.
  
  
  METHODS
  All patients who underwent chemotherapy with palliative intent for metastatic colorectal cancer at a regional oncology centre between 1 January and 31 December 2009 were identified from a prospectively maintained local database. Six resectional liver surgeons blinded to patient management and outcome reviewed pretreatment imaging and assigned each scan a score based on their own management choice. A consensus decision was reached on the appropriateness of palliative chemotherapy.
  
  
  RESULTS
  One hundred and ten patients were treated with palliative chemotherapy, of whom 53 had liver-only disease and had not been reviewed by a specialist liver surgeon. One scan was excluded as all reviewers felt it to be of insufficient quality to assess [corrected]. Tumours in 33 patients (63 per cent) were considered potentially resectable, with a high level of interobserver agreement (κ = 0 · 577). When individual approach to management was considered, interobserver agreement was less marked (κ = 0 · 378).
  
  
  CONCLUSIONS
  Management of patients with colorectal liver metastases without the involvement of a specialist liver multidisciplinary team can lead to patients being denied potentially curative treatments. Management of these patients must involve a specialist liver surgeon to ensure appropriate management.
authors.affiliation: School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. robjones@liv.ac.uk
authors.forename: R P
authors.initials: RP
authors.lastname: Jones
authors.forename: J-N
authors.initials: JN
authors.lastname: Vauthey
authors.forename: R
authors.initials: R
authors.lastname: Adam
authors.forename: M
authors.initials: M
authors.lastname: Rees
authors.forename: D
authors.initials: D
authors.lastname: Berry
authors.forename: R
authors.initials: R
authors.lastname: Jackson
authors.forename: N
authors.initials: N
authors.lastname: Grimes
authors.forename: S W
authors.initials: SW
authors.lastname: Fenwick
authors.forename: G J
authors.initials: GJ
authors.lastname: Poston
authors.forename: H Z
authors.initials: HZ
authors.lastname: Malik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015179:Colorectal Neoplasms; D032921:Consensus; D003657:Decision Making; D005260:Female; D005762:Gastroenterology; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D015588:Observer Variation; D010166:Palliative Care / Q000379:methods; D011446:Prospective Studies
chemical_list: D000970:Antineoplastic Agents