结直肠肝转移消失的困境：管理的国际趋势的定义。

The dilemma of the disappearing colorectal liver metastases: defining international trends in management.

机构信息

Institute of Medical Sciences, University of Aberdeen, Scotland, UK; Department of HPB Surgery, NHS Grampian, Scotland, Aberdeen, UK.

Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy.

出版信息

HPB (Oxford). 2023 Apr;25(4):446-453. doi: 10.1016/j.hpb.2023.01.003. Epub 2023 Jan 28.

DOI:10.1016/j.hpb.2023.01.003

PMID:36775699

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.

摘要

目的

本调查旨在评估不同国家的肝脏外科医生在处理消失性结直肠肝转移瘤（dCRLM）方面的一致性程度。

背景

结直肠肝转移（CRLM）占结直肠癌死亡人数的一半。由于术前化疗的高利用率，部分或全部 CRLM 可能会消失（dCRLM），但 dCRLMs 的管理仍不清楚。

方法

使用在线平台向经验丰富的肝脏外科医生展示了 7 种模拟的 dCRLM 场景。使用多评分者 Kappa 法提交和分析治疗决策。分析了经验、场景复杂性以及 dCRLM 的位置和数量对治疗决策的影响。

结果

来自 25 个国家的 67 名肝脏外科医生完成了调查。在所有场景中，对于 dCRLM 的治疗策略都没有达成一致意见（Kappa 值为 0.12，IQR 为 0.20-0.32）。在难度评分较低的场景中，外科医生倾向于对 dCRLM 与可见 CRLM（vCRLM）一起进行手术切除，但一致性较差（Kappa 值为 0.32，IQR 为 0.19-0.51）。对于所有 CRLM 病变均消失的临床场景，没有达成一致意见（Kappa 值为 0.20）。