Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ontario, Canada.
HPB (Oxford). 2012 May;14(5):291-7. doi: 10.1111/j.1477-2574.2012.00440.x. Epub 2012 Feb 9.
The resectability of colorectal liver metastases is in part largely based on the surgeon's assessment of cross-sectional imaging. This process, while guided by principles, is subjective. The objective of the present study was to assess agreement between hepatic surgeons regarding the resectability of colorectal liver metastases.
Forty-six hepatic surgeons across Canada were invited. A patient with biologically favourable disease was presented after having received neoadjuvant chemotherapy. The scenario was matched with 10 different scrollable abdominal CT scans representing a maximum response after six cycles of chemotherapy. Surgeons were asked to offer an opinion on resectability of liver metastases, and whether they would use adjunct modalities to hepatic resection.
Twenty-six surgeons participated. Twenty responses were complete. The median number of scenarios deemed resectable was 6/10 (range 3-8). Two control scenarios demonstrated perfect agreement. Agreement on resectability was poor for 4/8 test scenarios, of which one scenario demonstrated complete disagreement. Among resectable cases, the pattern of use of adjunct modalities was variable. A median ratio of 0.87 adjunct modality per resectable scenario per surgeon was used (range 0.25-1.75).
A significant lack of agreement was identified among surgeons on the resectability and use of adjunct modalities in the treatment of colorectal liver metastases.
结直肠肝转移的可切除性在很大程度上取决于外科医生对横断面成像的评估。尽管这一过程有原则可循，但仍具有主观性。本研究的目的是评估肝脏外科医生对结直肠肝转移可切除性的意见是否一致。
邀请了加拿大各地的 46 名肝脏外科医生。一名接受新辅助化疗后患有生物有利疾病的患者被纳入研究。该病例与 10 个不同的滚动式腹部 CT 扫描匹配，这些扫描代表了化疗 6 个周期后的最大反应。外科医生被要求对肝转移的可切除性以及是否使用辅助肝脏切除术的方法发表意见。
26 名外科医生参与了研究。20 名外科医生提供了完整的回复。中位数认为可切除的病例数为 6/10（范围 3-8）。两个对照病例完全一致。在 8 个测试病例中，有 4 个病例的可切除性意见不一致，其中一个病例完全不一致。在可切除的病例中，辅助治疗方法的使用模式存在差异。中位数每个可切除病例每个外科医生使用 0.87 个辅助治疗方法（范围 0.25-1.75）。
研究表明，外科医生在结直肠肝转移的可切除性和辅助治疗方法的使用方面存在显著的意见不一致。
