title: Clinical outcomes for patients with liver-limited metastatic colorectal cancer: Arguing the case for specialist hepatobiliary multidisciplinary assessment.
abstract: In patients with liver-limited metastatic colorectal cancer, hepatic resection can offer a significant survival benefit over systemic therapy alone. Specialist hepatobiliary multidisciplinary meetings are currently believed to provide the best forum to discuss the management for these patients. A retrospective analysis was undertaken of patients diagnosed with liver-limited metastatic colorectal cancer over 6 months within a cancer network in the United Kingdom. In addition, patients who were diagnosed but not referred to the hepatobiliary meeting were discussed within a virtual multi-disciplinary setting. Contributors were blinded and proposed management recorded. 159 newly diagnosed patients with liver-limited metastatic colorectal cancer were identified. 68 (43%) were referred at initial diagnosis and 38 (24%) referred following systemic treatment. 35 (51%) who were discussed at baseline underwent a subsequent hepatectomy or radiofrequency ablation, as did 18 (47%) patients referred after chemotherapy. Of the remaining 53 (33%) patients not referred, imaging was available for 31 (58%). Decisions regarding potential liver-directed therapy were discussed within a multi-disciplinary setting. 13 (42%) were identified as resectable or potentially resectable and 11 (36%) may have been suitable for a clinical trial. In reality, none of these 31 patients (100%) underwent surgery or ablation. Whilst the majority of patients with liver-limited metastatic colorectal cancer were referred appropriately, this study demonstrates that a significant number with potentially resectable disease are not being discussed at specialist meetings. A review of all diagnosed cases would ensure that an increased number of patients are offered hepatic resection or ablation.
authors.affiliation: Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Thillai
authors.affiliation: Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Repana
authors.affiliation: Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
authors.forename: I
authors.initials: I
authors.lastname: Korantzis
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Kane
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Prachalias
authors.affiliation: Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom; Institute of Liver Studies, King's College Hospital, London, United Kingdom. Electronic address: paul.ross@gstt.nhs.uk.
authors.forename: P
authors.initials: P
authors.lastname: Ross
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods; D000066491:Clinical Decision-Making; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D000072102:Gastroenterologists; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000379:methods; D008875:Middle Aged; D000072103:Oncologists; D010348:Patient Care Team / Q000458:organization & administration*; D000072177:Radiologists; D012017:Referral and Consultation; D012189:Retrospective Studies; D013038:Specialization; D066231:Surgeons; D006113:United Kingdom
keywords: Colorectal cancer; Hepatectomy; Hepatobiliary; Liver metastases; Multi-disciplinary meeting