TY - JOUR
T1 - Global survey on the surgical management of patients affected by colorectal cancer with synchronous liver metastases
T2 - impact of surgical specialty and geographic region
AU - Sijberden, Jasper Paul
AU - Spinelli, Antonino
AU - Ferrero, Alessandro
AU - Chand, Manish
AU - Wexner, Steven
AU - Besselink, Marc G.
AU - Dagher, Ibrahim
AU - Zimmitti, Giuseppe
AU - Görgec, Burak
AU - de Lacy, Antonio
AU - Roy, Mayank
AU - Tanis, Pieter
AU - Tonti, Carlo
AU - Abu Hilal, Mohammed
N1 - Funding Information: The authors would like to thank all respondents for taking the time to complete the questionnaire. Furthermore, they would like to thank the European Society of Coloproctology (ESCP), International-Hepato-Pancreato-Biliary Association (IHPBA) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) for supporting this project. Supplementary figure 5 was created using a custom-made map from MapChart (mapchart.net). Publisher Copyright: © 2023, The Author(s).
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Background: Consensus on the best surgical strategy for the management of synchronous colorectal liver metastases (sCRLM) has not been achieved. This study aimed to assess the attitudes of surgeons involved in the treatment of sCRLM. Methods: Surveys designed for colorectal, hepato-pancreato-biliary (HPB), and general surgeons were disseminated through representative societies. Subgroup analyses were performed to compare responses between specialties and continents. Results: Overall, 270 surgeons (57 colorectal, 100 HPB and 113 general surgeons) responded. Specialist surgeons more frequently utilized minimally invasive surgery (MIS) than general surgeons for colon (94.8% vs. 71.7%, p < 0.001), rectal (91.2% vs. 64.6%, p < 0.001), and liver resections (53% vs. 34.5%, p = 0.005). In patients with an asymptomatic primary, the liver-first two-stage approach was preferred in most respondents’ centres (59.3%), while the colorectal-first approach was preferred in Oceania (83.3%) and Asia (63.4%). A substantial proportion of the respondents (72.6%) had personal experience with minimally invasive simultaneous resections, and an expanding role for this procedure was foreseen (92.6%), while more evidence was desired (89.6%). Respondents were more reluctant to combine a hepatectomy with low anterior (76.3%) and abdominoperineal resections (73.3%), compared to right (94.4%) and left hemicolectomies (90.7%). Colorectal surgeons were less inclined to combine right or left hemicolectomies with a major hepatectomy than HPB and general surgeons (right: 22.8% vs. 50% and 44.2%, p = 0.008; left: 14% vs. 34% and 35.4%, p = 0.002, respectively). Conclusion: The clinical practices and viewpoints on the management of sCRLM differ between continents, and between and within surgical specialties. However, there appears to be consensus on a growing role for MIS and a need for evidence-based input. Graphical abstract: [Figure not available: see fulltext.]
AB - Background: Consensus on the best surgical strategy for the management of synchronous colorectal liver metastases (sCRLM) has not been achieved. This study aimed to assess the attitudes of surgeons involved in the treatment of sCRLM. Methods: Surveys designed for colorectal, hepato-pancreato-biliary (HPB), and general surgeons were disseminated through representative societies. Subgroup analyses were performed to compare responses between specialties and continents. Results: Overall, 270 surgeons (57 colorectal, 100 HPB and 113 general surgeons) responded. Specialist surgeons more frequently utilized minimally invasive surgery (MIS) than general surgeons for colon (94.8% vs. 71.7%, p < 0.001), rectal (91.2% vs. 64.6%, p < 0.001), and liver resections (53% vs. 34.5%, p = 0.005). In patients with an asymptomatic primary, the liver-first two-stage approach was preferred in most respondents’ centres (59.3%), while the colorectal-first approach was preferred in Oceania (83.3%) and Asia (63.4%). A substantial proportion of the respondents (72.6%) had personal experience with minimally invasive simultaneous resections, and an expanding role for this procedure was foreseen (92.6%), while more evidence was desired (89.6%). Respondents were more reluctant to combine a hepatectomy with low anterior (76.3%) and abdominoperineal resections (73.3%), compared to right (94.4%) and left hemicolectomies (90.7%). Colorectal surgeons were less inclined to combine right or left hemicolectomies with a major hepatectomy than HPB and general surgeons (right: 22.8% vs. 50% and 44.2%, p = 0.008; left: 14% vs. 34% and 35.4%, p = 0.002, respectively). Conclusion: The clinical practices and viewpoints on the management of sCRLM differ between continents, and between and within surgical specialties. However, there appears to be consensus on a growing role for MIS and a need for evidence-based input. Graphical abstract: [Figure not available: see fulltext.]
KW - Clinical practice pattern
KW - Colorectal cancer
KW - Surgical procedures
KW - Survey
KW - Synchronous colorectal liver metastases
UR - http://www.scopus.com/inward/record.url?scp=85149300898&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00464-023-09917-8
DO - https://doi.org/10.1007/s00464-023-09917-8
M3 - Article
C2 - 36879167
SN - 0930-2794
VL - 37
SP - 4658
EP - 4672
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 6
ER -