title: Surgical Resection Preferences and Perceptions among Medical Oncologists Treating Liver Metastases from Colorectal Cancer.
abstract: BACKGROUND
  Liver resection is a key therapeutic strategy to improve survival in patients with colorectal cancer liver metastases. Underutilization may negatively affect outcomes. Using a Web-based survey and standardized imaging scenarios, this study assessed medical oncologists' (MOs) perceptions of resectability, preferences for chemotherapy sequencing, and referral for surgical consultation in a static patient profile of good performance status and no extrahepatic spread but varying bulk and distribution of disease.
  
  
  METHODS
  A total of 190 US-based MOs were surveyed. A single patient profile was created and combined with 10 different sets of liver computed tomographic images displaying a broad spectrum of metastases. Assessments of resectability and ranking were compared with the results obtained from an expert panel of 3 hepatic surgeons.
  
  
  RESULTS
  The expert hepatic surgeons designated 8 scans resectable, 1 borderline resectable/convertible, and 1 unresectable. In the 8 resectable cases, 34.4 % of MOS perceived the case to be initially resectable, 41.7 % potentially resectable after chemotherapy response, and 23.9 % unresectable. Increasing number of lesions, larger tumor diameter, and bilateral disease were associated with lower resectability perception (P < 0.01). Among those cases considered resectable by MOs, they preferred initial resection (54.2 %) over neoadjuvant chemotherapy (38.4 %). Initial referral for surgical consultation was generally favored only for cases considered initially resectable by MOs.
  
  
  CONCLUSIONS
  This study confirms both potential discrepancies between MOs' and hepatic surgeons' perception of resectability and underutilization of early surgical consultation for patients with potentially resectable colorectal cancer liver metastases and underscores the importance of an evaluation that includes an experienced hepatic surgeon.
authors.affiliation: Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA. michael.choti@utsouthwestern.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.affiliation: Xcenda LLC, AmerisourceBergen Consulting Services, Palm Harbor, FL, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Bristol-Myers Squibb, Plainsboro, NJ, USA.
authors.forename: Schiffon L
authors.initials: SL
authors.lastname: Wong
authors.affiliation: Xcenda LLC, AmerisourceBergen Consulting Services, Palm Harbor, FL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Eaddy
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Weiss
authors.affiliation: Xcenda LLC, AmerisourceBergen Consulting Services, Palm Harbor, FL, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kish
authors.affiliation: Xcenda LLC, AmerisourceBergen Consulting Services, Palm Harbor, FL, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Green
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D013502:General Surgery / Q000592:standards*; D006498:Hepatectomy; D006801:Humans; D007400:Interprofessional Relations; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008495:Medical Oncology / Q000592:standards*; D008875:Middle Aged; D010348:Patient Care Team; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011300:Preoperative Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires