title: Improved outcomes of colorectal cancer patients with liver metastases in the era of the multidisciplinary teams.
abstract: OBJECTIVE
  The use of multidisciplinary teams (MDTs), which address colorectal cancer treatment planning through weekly regular group meetings, was begun in October 2007. We analyzed and compared the outcomes of colorectal cancer patients with metastatic disease before and after the era of MDTs.
  
  
  METHODS
  From 2001 to 2010, 1075 patients who presented with stage IV disease and were treated in Taipei Veterans General Hospital were enrolled in the study. Among these patients, 439 (40.8%) were diagnosed after MDTs had been established. The percentage of patients receiving surgical treatment for metastatic disease was calculated and compared before and after MDTs were established, and the survival rate was compared using a log-rank test, with a significance of P < 0.05.
  
  
  RESULTS
  A significantly improved survival rate in patients with stage IV disease was observed after establishment of MDTs, with the 3-year survival rate increasing from 25.6 to 38.2% (P < 0.001). Based on multivariate analysis, establishment of a MDT was an independent prognostic factor in patients with stage IV disease (hazard ratio = 0.74, 95% confidence interval = 0.624∼0.866, P < 0.001). The percentage of liver resection in patients with liver metastasis increased from 19.6 to 35.2% after the establishment of MDTs, whereas the percentage of lung resection in patients with lung metastasis remained stationary from 12.4 to 14.3%.
  
  
  CONCLUSIONS
  In the era of MDTs, intensive cooperation between different specialists has increased the referral rate for metastasectomy, resulting in significantly improved outcomes of colorectal patients in initial stage IV disease.
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, Taiwan, 11217.|Department of Surgery, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yuan-Tzu
authors.initials: YT
authors.lastname: Lan
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, Taiwan, 11217.|Department of Surgery, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Jeng-Kai
authors.initials: JK
authors.lastname: Jiang
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, Taiwan, 11217.|Department of Surgery, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Chang
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, Taiwan, 11217.|Department of Surgery, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shung-Haur
authors.initials: SH
authors.lastname: Yang
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, Taiwan, 11217.|Department of Surgery, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, Taiwan, 11217.|Department of Surgery, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hung-Hsin
authors.initials: HH
authors.lastname: Lin
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, Taiwan, 11217.|Department of Surgery, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Huann-Sheng
authors.initials: HS
authors.lastname: Wang
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, Taiwan, 11217.|Department of Surgery, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Wei-Shone
authors.initials: WS
authors.lastname: Chen
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, Taiwan, 11217.|Department of Surgery, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Lin
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, Taiwan, 11217. jklin@vghtpe.gov.tw.|Department of Surgery, National Yang-Ming University, Taipei, Taiwan. jklin@vghtpe.gov.tw.
authors.forename: Jen-Kou
authors.initials: JK
authors.lastname: Lin
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010347:Patient Care Planning; D010348:Patient Care Team; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Colorectal neoplasm; Metastasectomy; Multidisciplinary team; Outcome