Outcomes of Resectability Assessment of the Dutch Colorectal Cancer Group Liver Metastases Expert Panel

Abstract Introduction Decision making on optimal treatment strategy in patients with initially unresectable colorectal cancer liver metastases (CRLM) remains complex because uniform criteria for (un)resectability are lacking. This study reports on the feasibility and short-term outcomes of The Dutch Colorectal Cancer Group Liver Expert Panel. Methods The Expert Panel consists of thirteen hepatobiliary surgeons and four radiologists. Resectability assessment is performed independently by three randomly assigned surgeons. CRLM are scored as resectable, potentially resectable or permanently unresectable. In absence of consensus, two additional surgeons are invited for a majority consensus. Patients with potentially resectable or unresectable CRLM at baseline are evaluated every two months of systemic therapy. Once CRLM are considered resectable, a treatment strategy is proposed. Results Overall, 398 panel evaluations in 183 patients were analyzed. The median time to panel conclusion was 7 days (IQR 5-11). Inter-surgeon disagreement was observed in 205 (52%) evaluations, with major disagreement (resectable vs permanently unresectable) in 42 (11%) evaluations. After systemic treatment, 106 patients were considered to have resectable CRLM, out of which 84 (79%) patients underwent a curative procedure. R0 resection (n=41) or R0 resection in combination with ablative treatment (n=26) or ablative treatment only (n=4) was achieved in 67/84 (80%) patients. Conclusion This study analyzed prospective resectability evaluation of patients with CRLM by a panel of radiologists and liver surgeons. The high rate of disagreement among experienced liver surgeons reflects the complexity in defining treatment strategies for CRLM and supports the use of a panel rather than a single-surgeon decision.