Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, Brescia, Italy.
Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Surg Endosc. 2023 Jun;37(6):4658-4672. doi: 10.1007/s00464-023-09917-8. Epub 2023 Mar 6.
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.
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.
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).
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.
对于结直肠肝转移同步性（sCRLM）的最佳手术策略，尚未达成共识。本研究旨在评估参与 sCRLM 治疗的外科医生的态度。
通过代表学会向结直肠、肝胆胰（HPB）和普通外科医生分发了专门设计的调查。进行了亚组分析，以比较专业之间和各大洲之间的反应。
共有 270 名外科医生（57 名结直肠外科医生、100 名 HPB 外科医生和 113 名普通外科医生）做出了回应。专科医生比普通外科医生更频繁地将微创手术（MIS）用于结肠（94.8%比 71.7%，p<0.001）、直肠（91.2%比 64.6%，p<0.001）和肝脏切除术（53%比 34.5%，p=0.005）。在无症状原发灶患者中，大多数受访者中心首选两阶段肝优先方法（59.3%），而大洋洲（83.3%）和亚洲（63.4%）首选结直肠优先方法。相当一部分受访者（72.6%）有微创同时切除术的个人经验，并预计该手术的作用会扩大（92.6%），同时希望有更多的证据（89.6%）。与右半肝切除术（94.4%）和左半肝切除术（90.7%）相比，受访者更不愿意将肝切除术与低位前切除术（76.3%）和腹会阴联合切除术（73.3%）联合进行。与 HPB 和普通外科医生相比，结直肠外科医生不太倾向于将右半或左半肝切除术与大肝切除术联合进行（右半：22.8%比 50%和 44.2%，p=0.008；左半：14%比 34%和 35.4%，p=0.002）。
各大洲之间以及外科专业之间，在结直肠肝转移同步性（sCRLM）的治疗的临床实践和观点存在差异。然而，对于微创手术的作用不断扩大以及对循证输入的需求似乎存在共识。
