Abstract
Aim: A total of 15–20% of patients with rectal cancer have liver metastases on presentation. The management of these patients is controversial. Heterogeneity in management strategies is considerable, with management often being dependent on local resources and available expertise. Method: Members of the PelvEx Collaborative were invited to participate in the generation of a consensus statement on the optimal management of patients with advanced rectal cancer with liver involvement. Fifteen statements were created for topical discussion on diagnostic and management issues. Panellists were asked to vote on statements and anonymous feedback was given. A collaborative meeting was used to discuss any nuances and clarify any obscurity. Consensus was considered when > 85% agreement on a statement was achieved. Results: A total of 135 participants were involved in the final round of the Delphi questionnaire. Nine of the 15 statements reached consensus regarding the management of patients with advanced rectal cancer and oligometastatic liver disease. Routine use of liver MRI was not recommended for patients with locally advanced rectal cancer, unless there was concern for metastatic disease on initial computed tomography staging scan. Induction chemotherapy was advocated as first-line treatment in those with synchronous liver metastases in locally advanced rectal cancer. In the presence of symptomatic primary disease, a diverting stoma may be required to facilitate induction chemotherapy. Overall, only one-quarter of the panellists would consider simultaneous pelvic exenteration and liver resection. Conclusion: This Delphi process highlights the diverse treatment of advanced rectal cancer with liver metastases and provides recommendations from an experienced international group regarding the multidisciplinary management approach.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1184-1188 |
| Number of pages | 5 |
| Journal | Colorectal Disease |
| Volume | 22 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 1 2020 |
Keywords
- Rectal cancer
- international collaboration
- liver metastasis
- surgical outcomes
- survival outcomes
ASJC Scopus subject areas
- Gastroenterology
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Management strategies for patients with advanced rectal cancer and liver metastases using modified Delphi methodology : results from the PelvEx Collaborative. / Kelly, M. E.; Agj, Aalbers; Abdul Aziz, N.; Abecasis, N.; Abraham-Nordling, M.; Akiyoshi, T.; Alberda, W.; Albert, M.; Andric, M.; Angenete, E.; Antoniou, A.; Auer, R.; Austin, K. K.; Aziz, O.; Baker, R. P.; Bali, M.; Baseckas, G.; Bebington, B.; Bednarski, B. K.; Beets, G. L.; Berg, P. L.; Beynon, J.; Biondo, S.; Boyle, K.; Bordeianou, L.; Bremers, A. B.; Brunner, M.; Buchwald, P.; Bui, A.; Burgess, A.; Jwa, Burger; Burling, D.; Campain, N.; Carvalhal, S.; Castro, L.; Caycedo-Marulanda, A.; Kkl, Chan; Chang, G. J.; Chew, M. H.; Chong, P.; Christensen, H. K.; Clouston, H.; Codd, M.; Collins, D.; Colquhoun, A. J.; Corr, A.; Coscia, M.; Coyne, P. E.; Creavin, B.; Croner, R. S.; Damjanovic, L.; Daniels, I. R.; Davies, M.; Davies, R. J.; Delaney, C. P.; Jhw, de Wilt; Denost, Q.; Deutsch, C.; Dietz, D.; Domingo, S.; Dozois, E. J.; Duff, M.; Eglinton, T.; Enrique-Navascues, J. M.; Espin-Basany, E.; Evans, M. D.; Fearnhead, N. S.; Flatmark, K.; Fleming, F.; Frizelle, F. A.; Gallego, M. A.; Garcia-Granero, E.; Garcia-Sabrido, J. L.; Gentilini, L.; George, M. L.; Ghouti, L.; Giner, F.; Ginther, N.; Glynn, R.; Golda, T.; Griffiths, B.; Harris, D. A.; Jaw, Hagemans; Hanchanale, V.; Harji, D. P.; Helewa, R. M.; Hellawell, G.; Heriot, A. G.; Hochman, D.; Hohenberger, W.; Holm, T.; Hompes, R.; Jenkins, J. T.; Kaffenberger, S.; Kandaswamy, G. V.; Kapur, S.; Kanemitsu, Y.; Kelley, S. R.; Keller, D. S.; Khan, M. S.; Kiran, R. P.; Kim, H.; Kim, H. J.; Koh, C. E.; Nfm, Kok; Kokelaar, R.; Kontovounisios, C.; Kristensen, H.; Kroon, H. M.; Kusters, M.; Lago, V.; Larsen, S. G.; Larson, D. W.; Law, W. L.; Laurberg, S.; Lee, P. J.; Limbert, M.; Lydrup, M. L.; Lyons, A.; Lynch, A. C.; Mantyh, C.; Mathis, K. L.; Cfs, Margues; Martling, A.; Wjhj, Meijerink; Merkel, S.; Mehta, A. M.; McArthur, D. R.; McDermott, F. D.; McGrath, J. S.; Malde, S.; Mirnezami, A.; Jrt, Monson; Morton, J. R.; Mullaney, T. G.; Negoi, I.; Jwm, Neto; Nguyen, B.; Nielsen, M. B.; Gap, Nieuwenhuijzen; Nilsson, P. J.; O'Connell, P. R.; O'Dwyer, S. T.; Palmer, G.; Pappou, E.; Park, J.; Patsouras, D.; Pellino, G.; Peterson, A. C.; Poggioli, G.; Proud, D.; Quinn, M.; Quyn, A.; Radwan, R. W.; Rasheed, S.; Rasmussen, P. C.; Regenbogen, S. E.; Renehan, A.; Rocha, R.; Rochester, M.; Rohila, J.; Rothbarth, J.; Rottoli, M.; Roxburgh, C.; Hjt, Rutten; Ryan, J.; Safar, B.; Sagar, P. M.; Sahai, A.; Saklani, A.; Sammour, T.; Sayyed, R.; Amp, Schizas; Schwarzkopf, E.; Scripcariu, V.; Selvasekar, C.; Shaikh, I.; Shida, D.; Simpson, A.; Smart, N. J.; Smart, P.; Smith, J. J.; Solbakken, A. M.; Solomon, M. J.; Sørensen, M. M.; Steele, S. R.; Steffens, D.; Stitzenberg, K.; Stocchi, L.; Stylianides, N. A.; Sumrien, H.; Sutton, P. A.; Swartking, T.; Taylor, C.; Tekkis, P. P.; Teras, J.; Thurairaja, R.; Toh, E. L.; Tsarkov, P.; Tsukada, Y.; Tsukamoto, S.; Tuech, J. J.; Turner, W. H.; Tuynman, J. B.; Gh, van Ramshorst; D, van Zoggel; Vasquez-Jimenez, W.; Verhoef, C.; Vizzielli, G.; Elk, Voogt; Uehara, K.; Wakeman, C.; Warrier, S.; Wasmuth, H. H.; Weber, K.; Weiser, M. R.; Jmd, Wheeler; Wild, J.; Wilson, M.; Wolthuis, A.; Yano, H.; Yip, B.; Yip, J.; Yoo, R. N.; Winter, D. C.
In: Colorectal Disease, Vol. 22, No. 9, 01.09.2020, p. 1184-1188.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Management strategies for patients with advanced rectal cancer and liver metastases using modified Delphi methodology
T2 - results from the PelvEx Collaborative
AU - Kelly, M. E.
AU - Agj, Aalbers
AU - Abdul Aziz, N.
AU - Abecasis, N.
AU - Abraham-Nordling, M.
AU - Akiyoshi, T.
AU - Alberda, W.
AU - Albert, M.
AU - Andric, M.
AU - Angenete, E.
AU - Antoniou, A.
AU - Auer, R.
AU - Austin, K. K.
AU - Aziz, O.
AU - Baker, R. P.
AU - Bali, M.
AU - Baseckas, G.
AU - Bebington, B.
AU - Bednarski, B. K.
AU - Beets, G. L.
AU - Berg, P. L.
AU - Beynon, J.
AU - Biondo, S.
AU - Boyle, K.
AU - Bordeianou, L.
AU - Bremers, A. B.
AU - Brunner, M.
AU - Buchwald, P.
AU - Bui, A.
AU - Burgess, A.
AU - Jwa, Burger
AU - Burling, D.
AU - Campain, N.
AU - Carvalhal, S.
AU - Castro, L.
AU - Caycedo-Marulanda, A.
AU - Kkl, Chan
AU - Chang, G. J.
AU - Chew, M. H.
AU - Chong, P.
AU - Christensen, H. K.
AU - Clouston, H.
AU - Codd, M.
AU - Collins, D.
AU - Colquhoun, A. J.
AU - Corr, A.
AU - Coscia, M.
AU - Coyne, P. E.
AU - Creavin, B.
AU - Croner, R. S.
AU - Damjanovic, L.
AU - Daniels, I. R.
AU - Davies, M.
AU - Davies, R. J.
AU - Delaney, C. P.
AU - Jhw, de Wilt
AU - Denost, Q.
AU - Deutsch, C.
AU - Dietz, D.
AU - Domingo, S.
AU - Dozois, E. J.
AU - Duff, M.
AU - Eglinton, T.
AU - Enrique-Navascues, J. M.
AU - Espin-Basany, E.
AU - Evans, M. D.
AU - Fearnhead, N. S.
AU - Flatmark, K.
AU - Fleming, F.
AU - Frizelle, F. A.
AU - Gallego, M. A.
AU - Garcia-Granero, E.
AU - Garcia-Sabrido, J. L.
AU - Gentilini, L.
AU - George, M. L.
AU - Ghouti, L.
AU - Giner, F.
AU - Ginther, N.
AU - Glynn, R.
AU - Golda, T.
AU - Griffiths, B.
AU - Harris, D. A.
AU - Jaw, Hagemans
AU - Hanchanale, V.
AU - Harji, D. P.
AU - Helewa, R. M.
AU - Hellawell, G.
AU - Heriot, A. G.
AU - Hochman, D.
AU - Hohenberger, W.
AU - Holm, T.
AU - Hompes, R.
AU - Jenkins, J. T.
AU - Kaffenberger, S.
AU - Kandaswamy, G. V.
AU - Kapur, S.
AU - Kanemitsu, Y.
AU - Kelley, S. R.
AU - Keller, D. S.
AU - Khan, M. S.
AU - Kiran, R. P.
AU - Kim, H.
AU - Kim, H. J.
AU - Koh, C. E.
AU - Nfm, Kok
AU - Kokelaar, R.
AU - Kontovounisios, C.
AU - Kristensen, H.
AU - Kroon, H. M.
AU - Kusters, M.
AU - Lago, V.
AU - Larsen, S. G.
AU - Larson, D. W.
AU - Law, W. L.
AU - Laurberg, S.
AU - Lee, P. J.
AU - Limbert, M.
AU - Lydrup, M. L.
AU - Lyons, A.
AU - Lynch, A. C.
AU - Mantyh, C.
AU - Mathis, K. L.
AU - Cfs, Margues
AU - Martling, A.
AU - Wjhj, Meijerink
AU - Merkel, S.
AU - Mehta, A. M.
AU - McArthur, D. R.
AU - McDermott, F. D.
AU - McGrath, J. S.
AU - Malde, S.
AU - Mirnezami, A.
AU - Jrt, Monson
AU - Morton, J. R.
AU - Mullaney, T. G.
AU - Negoi, I.
AU - Jwm, Neto
AU - Nguyen, B.
AU - Nielsen, M. B.
AU - Gap, Nieuwenhuijzen
AU - Nilsson, P. J.
AU - O'Connell, P. R.
AU - O'Dwyer, S. T.
AU - Palmer, G.
AU - Pappou, E.
AU - Park, J.
AU - Patsouras, D.
AU - Pellino, G.
AU - Peterson, A. C.
AU - Poggioli, G.
AU - Proud, D.
AU - Quinn, M.
AU - Quyn, A.
AU - Radwan, R. W.
AU - Rasheed, S.
AU - Rasmussen, P. C.
AU - Regenbogen, S. E.
AU - Renehan, A.
AU - Rocha, R.
AU - Rochester, M.
AU - Rohila, J.
AU - Rothbarth, J.
AU - Rottoli, M.
AU - Roxburgh, C.
AU - Hjt, Rutten
AU - Ryan, J.
AU - Safar, B.
AU - Sagar, P. M.
AU - Sahai, A.
AU - Saklani, A.
AU - Sammour, T.
AU - Sayyed, R.
AU - Amp, Schizas
AU - Schwarzkopf, E.
AU - Scripcariu, V.
AU - Selvasekar, C.
AU - Shaikh, I.
AU - Shida, D.
AU - Simpson, A.
AU - Smart, N. J.
AU - Smart, P.
AU - Smith, J. J.
AU - Solbakken, A. M.
AU - Solomon, M. J.
AU - Sørensen, M. M.
AU - Steele, S. R.
AU - Steffens, D.
AU - Stitzenberg, K.
AU - Stocchi, L.
AU - Stylianides, N. A.
AU - Sumrien, H.
AU - Sutton, P. A.
AU - Swartking, T.
AU - Taylor, C.
AU - Tekkis, P. P.
AU - Teras, J.
AU - Thurairaja, R.
AU - Toh, E. L.
AU - Tsarkov, P.
AU - Tsukada, Y.
AU - Tsukamoto, S.
AU - Tuech, J. J.
AU - Turner, W. H.
AU - Tuynman, J. B.
AU - Gh, van Ramshorst
AU - D, van Zoggel
AU - Vasquez-Jimenez, W.
AU - Verhoef, C.
AU - Vizzielli, G.
AU - Elk, Voogt
AU - Uehara, K.
AU - Wakeman, C.
AU - Warrier, S.
AU - Wasmuth, H. H.
AU - Weber, K.
AU - Weiser, M. R.
AU - Jmd, Wheeler
AU - Wild, J.
AU - Wilson, M.
AU - Wolthuis, A.
AU - Yano, H.
AU - Yip, B.
AU - Yip, J.
AU - Yoo, R. N.
AU - Winter, D. C.
N1 - Publisher Copyright: © 2020 The Association of Coloproctology of Great Britain and Ireland Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Aim: A total of 15–20% of patients with rectal cancer have liver metastases on presentation. The management of these patients is controversial. Heterogeneity in management strategies is considerable, with management often being dependent on local resources and available expertise. Method: Members of the PelvEx Collaborative were invited to participate in the generation of a consensus statement on the optimal management of patients with advanced rectal cancer with liver involvement. Fifteen statements were created for topical discussion on diagnostic and management issues. Panellists were asked to vote on statements and anonymous feedback was given. A collaborative meeting was used to discuss any nuances and clarify any obscurity. Consensus was considered when > 85% agreement on a statement was achieved. Results: A total of 135 participants were involved in the final round of the Delphi questionnaire. Nine of the 15 statements reached consensus regarding the management of patients with advanced rectal cancer and oligometastatic liver disease. Routine use of liver MRI was not recommended for patients with locally advanced rectal cancer, unless there was concern for metastatic disease on initial computed tomography staging scan. Induction chemotherapy was advocated as first-line treatment in those with synchronous liver metastases in locally advanced rectal cancer. In the presence of symptomatic primary disease, a diverting stoma may be required to facilitate induction chemotherapy. Overall, only one-quarter of the panellists would consider simultaneous pelvic exenteration and liver resection. Conclusion: This Delphi process highlights the diverse treatment of advanced rectal cancer with liver metastases and provides recommendations from an experienced international group regarding the multidisciplinary management approach.
AB - Aim: A total of 15–20% of patients with rectal cancer have liver metastases on presentation. The management of these patients is controversial. Heterogeneity in management strategies is considerable, with management often being dependent on local resources and available expertise. Method: Members of the PelvEx Collaborative were invited to participate in the generation of a consensus statement on the optimal management of patients with advanced rectal cancer with liver involvement. Fifteen statements were created for topical discussion on diagnostic and management issues. Panellists were asked to vote on statements and anonymous feedback was given. A collaborative meeting was used to discuss any nuances and clarify any obscurity. Consensus was considered when > 85% agreement on a statement was achieved. Results: A total of 135 participants were involved in the final round of the Delphi questionnaire. Nine of the 15 statements reached consensus regarding the management of patients with advanced rectal cancer and oligometastatic liver disease. Routine use of liver MRI was not recommended for patients with locally advanced rectal cancer, unless there was concern for metastatic disease on initial computed tomography staging scan. Induction chemotherapy was advocated as first-line treatment in those with synchronous liver metastases in locally advanced rectal cancer. In the presence of symptomatic primary disease, a diverting stoma may be required to facilitate induction chemotherapy. Overall, only one-quarter of the panellists would consider simultaneous pelvic exenteration and liver resection. Conclusion: This Delphi process highlights the diverse treatment of advanced rectal cancer with liver metastases and provides recommendations from an experienced international group regarding the multidisciplinary management approach.
KW - Rectal cancer
KW - international collaboration
KW - liver metastasis
KW - surgical outcomes
KW - survival outcomes
UR - http://www.scopus.com/inward/record.url?scp=85081276063&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85081276063&partnerID=8YFLogxK
U2 - 10.1111/codi.15007
DO - 10.1111/codi.15007
M3 - Article
C2 - 32043753
AN - SCOPUS:85081276063
VL - 22
SP - 1184
EP - 1188
JO - Colorectal Disease
JF - Colorectal Disease
SN - 1462-8910
IS - 9
ER -