Attitudes of Canadian Colorectal Cancer Care Providers towards Liver Transplantation for Colorectal Liver Metastases: A National Survey.

Gonzalo Sapisochin,Filomena Servidio-Italiano,Keegan Guidolin,Woo Jin Choi,Fayez Quereshy

doi:10.3390/curroncol29020054

Gonzalo Sapisochin, Filomena Servidio-Italiano + Show 3 more

Open Access

https://doi.org/10.3390/curroncol29020054

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Abstract

Up to 50% of colorectal cancer (CRC) patients develop colorectal liver metastases (CRLM). The aim of this study was to gauge the awareness and perception of liver transplantation (LT) for non-resectable CRLM, and to describe the current referral patterns and management strategies for CRLM in Canada. Surgeons who provide care for patients with CRC were invited to an online survey through the Canadian Association of General Surgeons, the Canadian Society of Colon and Rectal Surgeons, and the Canadian Society of Surgical Oncology. Thirty-seven surveys were included. The most utilized management strategy for CRLM was to refer to a hepatobiliary surgeon for assessment of metastectomy (78%), and/or refer to medical oncologists for consideration of chemotherapy (73%). Among the respondents, 84% reported that their level of knowledge about LT for CRLM was low, yet the perception of exploring the option of LT for non-resectable CRLM seemed generally favorable (81%). The decision to refer for consideration of LT for CRLM treatment seemed to depend on patient-specific factors and the local hepatobiliary surgeon’s recommendation. Providing CRC care providers with educational materials on up-to-date CRLM management may help raise the awareness of the use of LT for non-resectable CRLM.

Highlights

Colorectal cancer (CRC) is the third most common cause of cancer death worldwide, with over 2 million new cases diagnosed each year, and more than 1 million related deaths [1]
In cases where the colorectal metastases are isolated to the liver, the total hepatectomy resulting from liver transplantation (LT) offers a chance of cure by removing all disease [5]
One survey was excluded because the respondent did not meet the inclusion criteria of providing colorectal cancer (CRC) care

Summary

Introduction

Colorectal cancer (CRC) is the third most common cause of cancer death worldwide, with over 2 million new cases diagnosed each year, and more than 1 million related deaths [1]. The liver is the most common site of metastasis for CRC, and it is reported that up to 50% of CRC patients develop colorectal liver metastases (CRLM) [2,3]. The combination of surgery and chemotherapy is the only accepted curative treatment option; it has been estimated that 60–80% of patients with CRLM are not candidates for liver resection for reasons such as insufficient liver remnant volume or high tumor burden [4]. In cases where the colorectal metastases are isolated to the liver, the total hepatectomy resulting from liver transplantation (LT) offers a chance of cure by removing 4.0/). CRLM is considered an absolute contraindication for LT at most centers, leaving palliative treatment as the only remaining option [5].

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