Precision surgery for colorectal liver metastases: Opportunities and challenges of omics-based decision making

2017 ◽  
Vol 43 (5) ◽  
pp. 875-883 ◽  
Author(s):  
R.P. Jones ◽  
K.W. Brudvik ◽  
J.M. Franklin ◽  
G.J. Poston
Keyword(s):  
Decision Making ◽  
Liver Metastases ◽  
Colorectal Liver Metastases

SP6.1.2 Colorectal Liver Metastases - Novel Assessment Tools for Resectability (The CoNoR Study): Results from an International Questionnaire of Hepatopancreatobiliary Surgeons

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Kat Parmar ◽  
Derek O'Reilly ◽  
Rob Jones ◽  
Fady Balaa ◽  
Fenella Welsh ◽  
...  
Keyword(s):  
Decision Making ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Community Support ◽  
Assessment Tools ◽  
Response Analysis ◽  
Free Text ◽  
The Novel ◽  
Liver Remnant ◽  
Study Results

Abstract Aims Hepatic resection offers the only chance of cure for colorectal liver metastases (CLM), yet wide variation in resectability decision-making has been demonstrated. This study aims to evaluate the potential value of two novel assessment tools in aiding resectability decision-making: the LiMAx test (hepatic functional capacity) and HepaT1ca interactive pre-operative MR scan (MR-based volumetry and functional assessment). Methods This study utilises four workstreams: WS1 systematic review, WS2 international HPB interviews, WS3 international HPB online questionnaire, and WS4 online scenario-based survey to assess change in decision-making resulting from the novel tools. The WS3 questionnaire closed in January 2021; participation was increased by professional association endorsement (AUGIS, GBIHPBA, E-AHPBA, AHPBA, CHPBA, IHPBA). Results 197 complete responses were received from 37 countries in 6 continents. The clinical scenario in which HPB surgeons found resectability decisions most challenging was post-chemotherapy downsizing, with >90% of respondents agreeing that the following scenarios also present a challenge: recurrent disease post-liver resection, post-portal vein embolisation, and close proximity to major ducts/vessels. Substantial variation was demonstrated in the percentage future liver remnant at which surgeons preferred further investigation in all scenarios. >90% of respondents felt the novel tools would be potentially useful in decision-making; wide-ranging free-text feedback was also provided. Conclusions The questionnaire lends support to the previously documented variation in resectability decision-making and confirms international HPB community support for investigation of these novel tools. Response analysis has facilitated the appropriate case selection to best assess their potential utility in the WS4 survey, due to launch this spring.

scholarly journals Erratum: Effect of specialist decision-making on treatment strategies for colorectal liver metastases

2012 ◽  
Vol 99 (11) ◽  
pp. 1605-1605 ◽  
Author(s):  
R. P. Jones ◽  
J.-N. Vauthey ◽  
R. Adam ◽  
M. Rees ◽  
D. Berry ◽  
...  
Keyword(s):  
Decision Making ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Treatment Strategies

scholarly journals O5: THE CLIFF AND CONOR STUDIES NOVEL ASSESSMENT TOOLS IN COLORECTAL LIVER METASTASES (CLIFF STUDY - CHANGE IN LIVER FUNCTION AND FAT IN PRE-OPERATIVE CHEMOTHERAPY FOR COLORECTAL LIVER METASTASES, CONOR STUDY

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
KL Parmar ◽  
C Slawinski ◽  
L Malcomson ◽  
D OReilly ◽  
JW Valle ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Liver Metastases ◽  
Patient Outcomes ◽  
Colorectal Liver Metastases ◽  
Assessment Tools ◽  
Liver Fat ◽  
Expert Interviews ◽  
Added Benefit ◽  
Improve Patient

Abstract Introduction Hepatic resection is the only potentially curative treatment for patients with colorectal liver metastases (CLM). Patient selection is key, but there is wide variation in practice. Pre-operative chemotherapy can improve oncological outcomes, however chemotherapy-associated liver injury (CALI) may hinder liver regenerative capacity. Standard pre-operative assessments fail to accurately capture factors such as CALI and future liver remnant (FLR) function. The CLiFF and CoNoR studies utilise two novel assessment techniques, aiming to improve patient outcomes. Method The CLiFF study prospectively assesses two primary outcomes in 35 patients undergoing pre-operative chemotherapy for CLM: 1) change in liver function (via LiMAx test: direct assessment of hepatic functional capacity), and 2) change in liver fat (via advanced MR imaging (in-house spectroscopy and modified Dixon technique, scaled up via Perspectum LiverMultiScan)). The CoNoR study assesses potential added benefit of these novel tools in CLM resectability decision-making via sequential workstreams: a systematic review and international hepatobiliary expert interviews inform the online survey, assessing added benefit via online MDT scenarios. Result Preliminary CLiFF analysis suggests that CALI changes in liver fat and function are unrelated. Liver fat analysis techniques are compared and correlated with digital histological analysis. The CoNoR systematic review identifies key factors influencing CLM resectability decision-making and informs the international expert interviews, scheduled to occur during a February 2020 international hepatobiliary conference. Conclusion These studies are the first to assess where these novel tools might be utilised to maximal patient benefit within the Hepatobiliary MDT, and the first systematic review in CLM resectability decision-making. Take-home message These two linked studies evaluate the use of two novel assessment tools in the treatment of colorectal liver metastases, with the potential to improve patient selection for curative resection and patient outcomes. PATEY PRIZE SESSION

Cost-effectiveness and optimal diagnostic sequence of CT, MRI, and PET-CT in the management of colorectal liver metastases.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4132-4132
Author(s):  
Vincent S. Yip ◽  
Brendan Colins ◽  
Mei Y. Koay ◽  
Joseph Tang ◽  
Hulya Wieshmann ◽  
...  
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Liver Metastases ◽  
Ct Scan ◽  
Hybrid Model ◽  
Colorectal Liver Metastases ◽  
Optimal Sequence ◽  
Triple Assessment ◽  
Pet Ct ◽  
Ct And Mri

4132 Background: CT, PET-CT and MRI play a role in the decision making process in managing colorectal liver metastases (CRLM). This study aimed to determine the optimal sequence of these investigations in order to reduce the rate of futile laparotomy and improve cost effectiveness of treatment. Methods: All patients referred to our specialist multidisciplinary team (sMDT) with CRLM were reviewed to investigate specific reason(s) for not offering potentially curative surgery. Clinical parameters were recorded for analysis. Three hypothetical scenarios were derived for cost-effectiveness analyses: 1) “up-front” with all imaging prior to sMDT, 2) “sequential”, with individual imaging following each sMDT, and 3) “hybrid” with PET-CT and MRI after review of the initial CT scan. Results: 644 consecutive patients were reviewed. Following assessment of initial CT, 165 patients (26%) were referred for palliative chemotherapy. After further evaluation by PET +/- MRI, 307 patients proceeded for potentially curative resection. Of those excluded from surgery, 48% were following PET-CT. Median overall survival (OS) for the resection and palliative groups were 46 and 14 months respectively (p<0.001). Futile laparotomy rate was 5.5%.The optimum strategy of lowest average time to decision, and lowest average cost is the hybrid model. Cost-utility analyses demonstrated a saving of approx. £319 (USD$ 515) per patient compared to the other 2 models. Conclusions: Decision making regarding further imaging after initial CT scan for CRLM should be performed at the sMDT to minimise delays and maximise efficiency of resources allocation. Triple assessment with CT, PET and MRI and sMDT decision process may reduce risk of futile laparotomy. A hybrid model using PET and MRI following a sMDT discussion of the initial CT provides the most cost effective algorithm for the management of CRLM.

Effect of specialist decision-making on treatment strategies for colorectal liver metastases

2012 ◽  
Vol 99 (9) ◽  
pp. 1263-1269 ◽  
Author(s):  
R. P. Jones ◽  
J.-N. Vauthey ◽  
R. Adam ◽  
M. Rees ◽  
D. Berry ◽  
...  
Keyword(s):  
Decision Making ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Treatment Strategies
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