title: Treating patients with colon cancer liver metastasis: a nationwide analysis of therapeutic decision making.
abstract: BACKGROUND
  Criteria for resectability of colon cancer liver metastases (CLM) are evolving, yet little is known about how physicians choose a therapeutic strategy for potentially resectable CLM.
  
  
  METHODS
  Physicians completed a national Web-based survey that consisted of varied CLM conjoint tasks. Respondents chose among three treatment strategies: immediate liver resection (LR), preoperative chemotherapy followed by surgery (C → LR), or palliative chemotherapy (PC). Data were analyzed by multinomial logistic regression, yielding odds ratios (OR).
  
  
  RESULTS
  Of 219 respondents, 79 % practiced at academic centers and 63 % were in practice ≥10 years. Median number of cases evaluated was four per month. Surgical training varied: 51 % surgical oncology, 44 % hepato-pancreato-biliary/transplantation, 5 % no fellowship. Although each factor affected the choice of CLM therapy, the relative effect differed. Hilar lymph node disease predicted a strong aversion to LR with surgeons more likely to choose C → LR (OR 8.92) or PC (OR 49.9). Solitary lung metastasis also deterred choice of LR, with respondents favoring C → LR (OR 4.43) or PC (OR 6.97). After controlling for clinical factors, surgeons with more years in practice were more likely to choose PC over C → LR (OR 1.94) (P = 0.005). Surgical oncology-trained surgeons were more likely than hepatobiliary/transplant-trained surgeons to choose C → LR (OR 2.53) or PC (OR 4.15) (P < 0.001).
  
  
  CONCLUSIONS
  This is the first nationwide study to define the relative impact of key clinical factors on choice of therapy for CLM. Although clinical factors influence choice of therapy, surgical subspeciality and physician experience are also important determinants of care.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Hari
authors.initials: H
authors.lastname: Nathan
authors.forename: John F
authors.initials: JF
authors.lastname: Bridges
authors.forename: David P
authors.initials: DP
authors.lastname: Cosgrove
authors.forename: Luis A
authors.initials: LA
authors.lastname: Diaz
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Laheru
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000628:therapy*; D003131:Combined Modality Therapy; D003657:Decision Making; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D011878:Radiotherapy
chemical_list: D000970:Antineoplastic Agents