Variation in referral practice for patients with colorectal cancer liver metastases
Variation in referral practice for patients with colorectal cancer liver metastases
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DOI：
10.1002/bjs.9285
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发表时间：
2013-11-01
影响因子：
9.6
通讯作者：
Prasad, K. R.
中科院分区：
文献类型：
--
作者：
Young, A. L.;Adair, R.;Prasad, K. R.
一半的结直肠癌患者会发生肝转移。在不同的医院之间，结直肠癌肝转移（CLM）的肝切除率仍然存在很大的差异。本研究旨在确定有多少可能可切除的CLM患者没有被专业肝脏外科医生看到。方法对由三级中心和7家附属医院组成的癌症网络中出现的新CLM患者进行为期12个月的前瞻性研究。对于没有完整数据集的患者，回顾性收集数据。对转入肝脏三级中心的患者的预后进行整理。由肝脏专科医生及放射科医生检讨由本地结直肠专科医生小组认为不能手术的肿瘤的放射学。结果共评估631例CLM患者。241例患者的前瞻性数据是完整的，其中64例（266%）被转到肝脏专家小组考虑切除。16例患者（66%）未作出决定。在未被转诊的患者中，30人（186%）被认为不适合或拒绝，131人（814%）被认为无法手术。医院间转诊率各不相同（13- 436%）。131例经结直肠专家小组认为适合但不能手术的患者中，38例（290%）被认为可以手术，20例（153%）经肝脏专家回顾性评估有模棱两可的影像。在631名患者中，总共有142名患者被转介给肝脏专家考虑治疗，107名（754%）患者接受了治疗。结论相当一部分有切除潜力的CLM患者没有经过专业肝脏小组的评估。提高转诊率可以大大提高CLM的切除率，这可能改善结直肠癌患者的预后。
BackgroundHalf of patients with colorectal cancer develop liver metastases. There remains great variability between hospitals in rates of liver resection for colorectal cancer liver metastases (CLM). This study aimed to determine how many patients with potentially resectable CLM are not seen by specialist liver surgeons.MethodsPatients presenting with new CLM in a cancer network consisting of a tertiary centre and seven attached hospitals were studied prospectively over 12 months. Data were collected retrospectively for patients who did not have a complete data set. Outcomes for patients referred to the liver tertiary centre were collated. The radiology of tumours deemed inoperable by the local colorectal specialist teams was reviewed by specialist liver surgeons and radiologists.ResultsIn total, 631 patients with CLM were assessed. Prospective data were complete for 241 patients, and 64 (266 per cent) of these were referred to the specialist liver team for consideration of resection. No decision was documented for 16 patients (66 per cent). Of those not referred, 30 (186 per cent) were deemed unfit or refused and 131 (814 per cent) were thought inoperable. Referral rates varied between hospitals (13-436 per cent). Of 131 patients deemed fit but inoperable by the colorectal specialist teams, 38 (290 per cent) were deemed operable and 20 (153 per cent) had equivocal imaging when assessed retrospectively by liver specialists. In total, 142 of the 631 patients were referred to liver specialists for consideration of treatments, and 107 (754 per cent) treated with curative intent.ConclusionA considerable number of patients with potentially resectable CLM are not assessed by specialist liver teams. Improved referral rates could greatly improve resection rates for CLM, which may improve outcomes for patients with colorectal cancer.