Simultaneous resection of colorectal cancer with synchronous liver metastases: A survey-based analysis.
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662 Background: Decision to proceed with simultaneous or staged resection in synchronous colorectal cancer liver metastases (CRLM) varies and is usually left to the individual surgeon. We examined practice intentions and barriers to performing simultaneous resection. Methods: We developed and pilot-tested a tailored questionnaire. Members of the Society of Surgical Oncology and the College of Physicians and Surgeons of Ontario operating colorectal cancer were surveyed electronically. Four clinical scenarios of synchronous CRLM determined practice intentions for varying degrees of complexity. Perceived barriers were assessed on a 7-point Likert scale. We compared general and hepatobiliary surgeons’ responses with Mann-Whitney U test for continuous variables and Chi-square test for categorical variables. Results: There were 184/1,335 surgeons (14% response rate), including 50 general and 134 hepatobiliary surgeons. Both were supportive of simultaneous resection, though hepatobiliary surgeons were more so; for minor liver and low complexity colorectal resections (Likert ≥5-7: 83% vs. 98% p<0.001), or for complex colorectal resections (57% vs. 73% p=0.042). Both groups were less supportive of simultaneous resection for complex liver with low complexity (Likert ≥5-7: 26% vs. 24% respectively, p=0.858) or high complexity colorectal resections (11% vs. 7.0% respectively, p=0.436). All perceived that simultaneous resection increases post-operative morbidity (63%), but not mortality (69%). Among hepatobiliary surgeons, the most common barriers for simultaneous resections were comorbidities and extrahepatic disease, whereas general surgeons were more concerned about transfer to another facility. Conclusions: While general and hepatobiliary surgeons are supportive of simultaneous resection, especially for less complex liver resections; support is significantly lower among general surgeons. In addition to complexity of procedures and perceived morbidity, the need for transfer of care appears as a barrier to simultaneous resections. The practice intentions and barriers described are important to identify knowledge gaps, guide future trials, and establish disease care pathways.
