Abstract
Objective
This survey sought to appraise the degree of consistency in the management of disappeared
colorectal liver metastases (dCRLM) among liver surgeons in different countries.
Background
Colorectal liver metastases (CRLM) account for half of the deaths secondary to colorectal
cancer. Due to the high utilization of chemotherapy before surgery, some or all CRLM
can disappear (dCRLM) but management of dCRLMs remains unclear.
Methods
Seven simulated scenarios of dCRLM were presented to experienced liver surgeons using
an online platform. Treatment decisions were submitted and analysed using the multi-rater
kappa method. The effect of the experience, complexity of scenarios, and location
and number of dCRLM on treatment decision were analysed.
Results
Sixty-seven liver surgeons from 25 countries completed the survey. There was no agreement
about the therapeutic strategies of dCRLM in all scenarios (kappa 0.12, IQR 0.20–0.32).
In scenarios with lower difficulty scores, surgeons tended to offer surgical resection
for dCRLM alongside the visible CRLM (vCRLM), however, with poor agreement (kappa
0.32, IQR 0.19–0.51). No agreement was seen for clinical scenario in which all CRLM
lesions disappeared (kappa 0.20).
Conclusion
There are clear inconsistencies in the management decisions of dCRLM. Better evidence
is required to define optimal management strategies.
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Article info
Publication history
Published online: January 27, 2023
Accepted:
January 10,
2023
Received:
August 30,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
