The impact of multidisciplinary team management on outcome of hepatic resection in liver-limited colorectal metastases.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
02 07 2020
02 07 2020
Historique:
received:
08
01
2020
accepted:
19
05
2020
entrez:
4
7
2020
pubmed:
4
7
2020
medline:
16
12
2020
Statut:
epublish
Résumé
Hepatic resection is the gold standard treatment for patients affected by liver-limited colorectal metastases. Reports addressing the impact of multidisciplinary team (MDT) evaluation on survival are controversial. The aim of this study was to evaluate the benefit of MDT management in these patients in our Institution experience. The objective of the analysis was to compare survivals of patients managed within our MDT (MDT cohort) to those of patients referred to surgery from other hospitals without MDT discussion (non-MDT cohort). Of the 523 patients, 229 were included in the MDT cohort and 294 in the non-MDT cohort. No difference between the two groups was found in terms of median overall survival (52.5 vs 53.6 months; HR 1.13; 95% CI, 0.88-1.45; p = 0.344). In the MDT cohort there was a higher number of metastases (4.5 vs 2.7; p < 0.0001). The median duration of chemotherapy was lower in MDT patients (8 vs 10 cycles; p < 0.001). Post-operative morbidity was lower in the MDT cohort (6.2 vs 21.5%; p < 0.001). One hundred and ninety-seven patients in each group were matched by propensity score and no significant difference was observed between the two groups in terms of OS and DFS. Our study does not demonstrate a survival benefit from MDT management, but it allows surgery to patients with a more advanced disease. MDT assessment reduces the median duration of chemotherapy and post-operative morbidities.
Identifiants
pubmed: 32616782
doi: 10.1038/s41598-020-67676-1
pii: 10.1038/s41598-020-67676-1
pmc: PMC7331814
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
10871Références
Siegel, R. L., Miller, K. D. & Jemal, A. Cancer statistics. CA Cancer J. Clin. 66, 7–30 (2016).
doi: 10.3322/caac.21332
Bray, F., Sankila, R., Ferlay, J. & Parkin, D. M. Estimates of cancer incidence and mortality in Europe in 2008. Eur. J. Cancer 46(4), 765–781 (2010).
doi: 10.1016/j.ejca.2009.12.014
Adam, R. et al. Toward optimized front-line therapeutic strategies in patients with metastatic colorectal cancer—an expert review from the International Congress on Anti-Cancer Treatment (ICACT) 2009. Ann. Oncol. 21, 1579–1584 (2010).
doi: 10.1093/annonc/mdq043
Shindoh, J. et al. Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant. J. Am. Coll. Surg. 216, 201–209 (2013).
doi: 10.1016/j.jamcollsurg.2012.10.018
Tomlinson, J. S. et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J. Clin. Oncol. 25, 4575–4580 (2007).
doi: 10.1200/JCO.2007.11.0833
Chua, T. C., Saxena, A., Chu, F., Zhao, J. & Morris, D. L. Predictors of cure after hepatic resection of colorectal liver metastases: an analysis of actual 5- and 10-year survivors. J. Surg. Oncol. 103, 796–800 (2011).
doi: 10.1002/jso.21864
Gleisner, A. L. et al. Colorectal liver metastases: recurrence and survival following hepatic resection, radiofrequency ablation, and combined resection-radiofrequency ablation. Arch. Surg. 143(12), 1204–1212 (2008).
doi: 10.1001/archsurg.143.12.1204
Kopetz, S. et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J. Clin. Oncol. 27, 3677–3683 (2009).
doi: 10.1200/JCO.2008.20.5278
Rougier, P. & Neoptolemos, J. P. The need for a multidisciplinary approach in the treatment of advanced colorectal cancer: a critical review from a medical oncologist and surgeon. Eur. J. Surg. Oncol. 23, 385–396 (1997).
doi: 10.1016/S0748-7983(97)93715-X
Ruhstaller, T., Roe, H., Thurlimann, B. & Nicoll, J. J. The multidisciplinary meeting: an indispensable aid to communication between different specialities. Eur. J. Cancer 42, 2459–2462 (2006).
doi: 10.1016/j.ejca.2006.03.034
MacDermid, E. et al. Improving patient survival with the colorectal cancer multi-disciplinary team. Colorectal Dis. 11(3), 291–295 (2009).
doi: 10.1111/j.1463-1318.2008.01580.x
Lan, Y. T., Jiang, J. K. & Chang, S. C. Improved outcomes of colorectal cancer patients with liver metastases in the era of the multidisciplinary teams. Int. J. Colorectal Dis. https://doi.org/10.1007/s00384-015-2459-4 (2015).
doi: 10.1007/s00384-015-2459-4
pubmed: 26662193
Lordan, J. T., Karanjia, N. D. & Quiney, N. A 10-year study of outcome following hepatic resection for colorectal liver metastases. The effect of evaluation in a multidisciplinary team setting. EJSO 35, 302–306 (2009).
doi: 10.1016/j.ejso.2008.01.028
Viganò, L., Langella, S. & Ferrero, A. Colorectal cancer with synchronous resectable liver metastases: monocentric management in a hepatobiliary referral center improves survival outcomes. Ann. Surg. Oncol. 20, 938–945 (2013).
doi: 10.1245/s10434-012-2628-4
Kanas, G. P. et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin. Epidemiol. 4, 283–301 (2012).
pubmed: 23152705
pmcid: 3496330
Ardito, F. et al. Chance of cure following liver resection for initially unresectable colorectal metastases: analysis of actual 5-year survival. J. Gastrointest. Surg. 17, 352–359 (2013).
doi: 10.1007/s11605-012-2103-3
Dindo, D., Demartines, N. & Clavien, P. A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 240, 205–213 (2004).
doi: 10.1097/01.sla.0000133083.54934.ae
Look Hong, N. J., Wright, F. C., Gagliardi, A. R. & Paszat, L. F. Examining the potential relationship between multidisciplinary cancer care and patient survival: an international literature review. J. Surg. Oncol. 102, 125–134 (2010).
doi: 10.1002/jso.21589