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Original Article |
1 Department of Surgical Oncology, Unit 444, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
2 Johns Hopkins University, Baltimore, MD 21287, USA
3 Department of Surgery, University of Illinois, Chicago, IL, USA
Correspondence: Address correspondence and reprint requests to: Jean-Nicolas Vauthey, MD; Department of Surgical Oncology, Unit 444, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA, E-mail: jvauthey{at}mdanderson.org
Key Words: Consensus conference • Hepatic metastases • Colorectal cancer
On January 25, 2006, the American Hepato-Pancreato-Biliary Association (AHPBA) convened a consensus conference on the Management of Hepatic Colorectal Metastases. The conference was cosponsored by the Society of Surgical Oncology, the Society for Surgery of the Alimentary Tract, and the Gastrointestinal Symposium Steering Committee. The goal of the conference was to review indications and contraindications to liver-directed therapy and adjuvant therapy for patients with hepatic colorectal metastases. This 1-day event was divided into three sessions addressing (1) selection of patients for resection, (2) methods of improving resectability, and (3) selection of systemic chemotherapy and regional therapy.
Those who read the consensus statements contained in the three manuscripts reflecting the proceedings of the conference should be aware of the methods used in arriving at the consensus statements. After extensive consultation and solicitation of names from the three sponsoring associations, a group of experts were invited to participate. Speakers with expertise were asked to present at a live forum followed by questions from a panel of appointed experts in the respective field of study and the audience. Each speaker was asked to conclude his or her presentation with a consensus statement. Panelists were asked to comment on the appropriateness of the speakers’ consensus statements. Three manuscripts were written by the speakers and panel chairs. The manuscripts were further reviewed and edited by the panelists, who provided an editorial comment appended to each manuscript to emphasize specific issues or provide alternate perspectives. This method of consensus is somewhat different from the National Institutes of Health (NIH) format in which experts present to an independent panel and the panel then writes the consensus statement without further input from the experts. The current format, however, provides an inclusive overview of points made by experts in the field and in addition provides for each set of statements a counterpoint in three editorial reviews appended to the manuscripts.
The consensus statements reflect important treatment aspects of the care of patients with hepatic colorecal metastases. The conference defined separately prognostic factors of survival and factors affecting resectability. The conference strongly recommended consideration of systemic chemotherapy as adjuvant to resection in chemonaive patients. The conference stated that the rationale to support some approaches, such as regional therapy or resection of extrahepatic disease (except in case of direct invasion, local regional recurrence or lung metastases), be further evaluated only as part of well-defined protocols. Important recommendations were made in support of imaging and radiological interventional techniques, such as the routine use of positron emission tomography (PET) prior to surgery or the selected use of preoperative portal vein embolization as a means to improve hepatic function prior to major resection. Within this increasingly complex multidisciplinary field, cautionary notes and recommendations for further studies of chemotherapy-associated hepatic injury were provided. Most importantly, it was recognized that surgeons and medical oncologists need to increasingly work together in the design and execution of future clinical trials to further improve outcomes of patients with colorectal liver metastases.
Received for publication May 8, 2006. Accepted for publication June 2, 2006.
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