Vasudevan S P, Cresswell A B, Wright J M, Rees M, Stiff D, Wordley A, Motson R W
The ICENI Centre, Colchester University Hospital NHS Foundation Trust, Colchester, UK.
Colorectal Dis. 2013;15(10):1253-6. doi: 10.1111/codi.12323.
The ongoing evolution of treatment strategies for colorectal liver metastases necessarily requires all patients to be reviewed at some point by the specialist hepatobiliary unit. This process can be streamlined through close collaboration with the local colorectal multidisciplinary team (MDT). The study was performed to see if a local colorectal MDT was able to make a correct decision regarding potential operability of liver metastases, by comparing its decision with that of two hepatobiliary surgeons in our referral centre.
CT scans of 38 patients found to have liver metastases from colorectal cancer were anonymized and sent to two hepatobiliary surgeons in our cancer network. They classified them into three categories: R, resectable; C, chemotherapy to downsize then consider resection; U, unresectable. The results were then compared with the opinion of our colorectal MDT, made before the referral to the hepatobiliary surgeons.
The two independent hepatobiliary surgeons agreed with each other on 35/38 (92%) of CT scans. Our colorectal MDT agreed with the hepatobiliary surgeons in 36/38 (95%) of cases. Only 9 (32%) of the 28 patients deemed suitable on the CT scan by the hepatobiliary surgeons actually had a liver resection.
The results show that a local colorectal MDT is able to make an accurate assessment of the operability of liver metastases. Patients deemed to be inoperable by the colorectal MDT could be 'fast-tracked' to the hepatobiliary MDT with review of imaging only, saving time and resources by avoiding referral of patients who are not suitable for liver resection.
结直肠癌肝转移治疗策略的不断演变必然要求所有患者在某个时间点由肝胆专科单位进行评估。通过与当地结直肠癌多学科团队（MDT）密切合作，这一过程可以得到简化。本研究旨在通过将当地结直肠癌MDT的决策与我们转诊中心的两位肝胆外科医生的决策进行比较，来观察当地结直肠癌MDT是否能够对肝转移的潜在可切除性做出正确决策。
对38例被发现有结直肠癌肝转移的患者的CT扫描进行匿名处理，并发送给我们癌症网络中的两位肝胆外科医生。他们将这些病例分为三类：R，可切除；C，先进行化疗缩小肿瘤大小然后考虑切除；U，不可切除。然后将结果与我们结直肠癌MDT在转诊给肝胆外科医生之前的意见进行比较。
两位独立的肝胆外科医生在38例CT扫描中的35例（92%）上意见一致。我们的结直肠癌MDT在38例病例中的36例（95%）上与肝胆外科医生意见一致。在肝胆外科医生通过CT扫描判定适合手术的28例患者中，只有9例（32%）实际进行了肝切除。
结果表明，当地结直肠癌MDT能够对肝转移的可切除性做出准确评估。被结直肠癌MDT判定为不可手术的患者可以仅通过影像检查被“快速转诊”至肝胆MDT，通过避免转诊不适合肝切除的患者来节省时间和资源。
