Management of colorectal cancer with synchronous liver metastases: impact of multidisciplinary case conference review

Abstract

Background: While no evidence exists to support mandatory multidisciplinary case conference (MCC) review for patients with synchronous colorectal cancer and liver metastases, this unique population may benefit greatly from multidisciplinary discussion. Methods:We retrospectively identified patients who underwent liver resection with curative intent for colorectal liver metastases (CRLM) at a tertiary center between January 2008 and June 2015. The characteristics of patients discussed at a weekly regional MCC were examined, and the effect of MCC review on treatment approach was assessed.Results: Sixty-six patients underwent elective surgery for synchronous colorectal cancer and liver metastases during the study period. Twenty-nine patients (44%) were presented at a MCC. Presentation was associated with greater likelihood of undergoing simultaneous or liver-first resection (P≤0.0001), with no difference in the extent of liver resection or location of primary tumor between the groups. A greater proportion of patients received chemotherapy and/or radiation following MCC discussion, without statistical significance. Conclusions:The treatment approach for patients with synchronous colorectal cancer and liver metastases may be significantly altered based on MCC review. Multidisciplinary discussion is advocated in order to facilitate equal access to individualized care.

Synchronous colorectal liver metastases: a national survey of surgeon opinions on simultaneous resection and multidisciplinary cooperation

“…Non-CRS might consider earlier referral of their asymptomatic and minimally symptomatic patients to multidisciplinary discussions that include HPB surgeons, medical oncologists and potentially CRS with the expectation that their involvement in these cases will remain intact. The power of multidisciplinary case conference review in particular has become evident (26). Only through continued improvement in our collaboration will we be able to define the treatment sequence that is best tailored to a given patient.…”

Treatment plan improvement by multidisciplinary case conferences for patients with colorectal cancer and synchronous liver metastases

“…With their current article, Wanis et al (4) showed for the first time that their institutional MCC led indeed to a significant adjustment in treatment strategies for patients with colorectal cancer and synchronous liver metastases. In particular, when comparing 29 patients undergoing surgery after their case having been presented at the MCC and 37 patients without case presentation, a significantly higher Editorial Treatment plan improvement by multidisciplinary case conferences for patients with colorectal cancer and synchronous liver metastases percentage of the cases discussed at the MCC had a change of treatment concept towards a more radical approach with liver resection such as liver-first or simultaneous primary colorectal cancer and liver metastases resection.…”

“…Finally, the work of Wanis et al (4) shows in an alarming way that the current process sequence with low case presentation rates at MCC deprives patients of the chance to obtain the best available treatment plan based on the current evidence. It underlines the necessity to put all efforts towards facilitating and coordinating MCC presentations in order to individualize optimally tailored treatment plans.…”

Treatment sequencing for simultaneous colorectal liver metastases

“…The fifth is most pertinent for rectal tumors in which preoperative chemotherapy and/or radiation and the “watch and wait” approach are considerations. These questions, particularly those pertaining to liver resectability and preoperative treatment for the primary, warrant discussion in a multidisciplinary conference to optimize patient outcomes …”

“…those pertaining to liver resectability and preoperative treatment for the primary, warrant discussion in a multidisciplinary conference to optimize patient outcomes. [12][13][14] The following sections will highlight the main considerations when discussing treatment sequence: recurrence risk, chemotherapy response and chemotherapy-related liver injury, and outcomes for combined and minimally invasive surgical approaches. Then, we will outline the pros and cons of different surgical sequence strategies for patients with resectable liver metastases.…”