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Defining the Optimal Therapy Sequence in Synchronous Resectable Liver Metastases from Colorectal Cancer: A Decision Analysis Approach

ELS VAN DESSEL (UGent) , KJELL FIERENS (UGent) , Piet Pattyn (UGent) , Yves Van Nieuwenhove (UGent) , Frederik Berrevoet (UGent) , Roberto Troisi (UGent) and Wim Ceelen (UGent)
(2009) ACTA CHIRURGICA BELGICA. 109(3). p.317-320
Author
Organization
Abstract
Introduction : Approximately 5%-20% of colorectal cancer (CRC) patients present with synchronous potentially resectable liver metastatic disease. Preclinical and clinical studies suggest a benefit of the 'liver first' approach, i.e. resection of the liver metastasis followed by resection of the primary tumour. A formal decision analysis may support a rational choice between several therapy options. Methods : Survival and morbidity data were retrieved from relevant clinical studies identified by a Web of Science (R) search. Data were entered into decision analysis software (TreeAge (R) Pro 2009, Williamstown, MA, USA). Transition probabilities including the risk of death from complications or disease progression associated with individual therapy options were entered into the model. Sensitivity analysis was performed to evaluate the model's validity under a variety of assumptions. Results : The result of the decision analysis confirms the superiority of the 'liver first' approach. Sensitivity analysis demonstrated that this assumption is valid on condition that the mortality associated with the hepatectomy first is <4.5%, and that the mortality of colectomy performed after hepatectomy is <3.2%. Conclusion : The results of this decision analysis suggest that, in patients with synchronous resectable colorectal liver metastases, the 'liver first' approach is to be preferred. Randomized trials will be needed to confirm the results of this. simulation based outcome.
Keywords
CARCINOMA, HEPATIC METASTASES, DORMANCY, MANAGEMENT, ANGIOSTATIN, SURGERY, CHEMOTHERAPY, RESECTION, MODEL, PRIMARY TUMOR

Citation

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MLA
VAN DESSEL, ELS et al. “Defining the Optimal Therapy Sequence in Synchronous Resectable Liver Metastases from Colorectal Cancer: A Decision Analysis Approach.” ACTA CHIRURGICA BELGICA 109.3 (2009): 317–320. Print.
APA
VAN DESSEL, E., FIERENS, K., Pattyn, P., Van Nieuwenhove, Y., Berrevoet, F., Troisi, R., & Ceelen, W. (2009). Defining the Optimal Therapy Sequence in Synchronous Resectable Liver Metastases from Colorectal Cancer: A Decision Analysis Approach. ACTA CHIRURGICA BELGICA, 109(3), 317–320.
Chicago author-date
VAN DESSEL, ELS, KJELL FIERENS, Piet Pattyn, Yves Van Nieuwenhove, Frederik Berrevoet, Roberto Troisi, and Wim Ceelen. 2009. “Defining the Optimal Therapy Sequence in Synchronous Resectable Liver Metastases from Colorectal Cancer: A Decision Analysis Approach.” Acta Chirurgica Belgica 109 (3): 317–320.
Chicago author-date (all authors)
VAN DESSEL, ELS, KJELL FIERENS, Piet Pattyn, Yves Van Nieuwenhove, Frederik Berrevoet, Roberto Troisi, and Wim Ceelen. 2009. “Defining the Optimal Therapy Sequence in Synchronous Resectable Liver Metastases from Colorectal Cancer: A Decision Analysis Approach.” Acta Chirurgica Belgica 109 (3): 317–320.
Vancouver
1.
VAN DESSEL E, FIERENS K, Pattyn P, Van Nieuwenhove Y, Berrevoet F, Troisi R, et al. Defining the Optimal Therapy Sequence in Synchronous Resectable Liver Metastases from Colorectal Cancer: A Decision Analysis Approach. ACTA CHIRURGICA BELGICA. BRUSSELS: ACTA MEDICAL BELGICA; 2009;109(3):317–20.
IEEE
[1]
E. VAN DESSEL et al., “Defining the Optimal Therapy Sequence in Synchronous Resectable Liver Metastases from Colorectal Cancer: A Decision Analysis Approach,” ACTA CHIRURGICA BELGICA, vol. 109, no. 3, pp. 317–320, 2009.
@article{880930,
  abstract     = {Introduction : Approximately 5%-20% of colorectal cancer (CRC) patients present with synchronous potentially resectable liver metastatic disease. Preclinical and clinical studies suggest a benefit of the 'liver first' approach, i.e. resection of the liver metastasis followed by resection of the primary tumour. A formal decision analysis may support a rational choice between several therapy options.
Methods : Survival and morbidity data were retrieved from relevant clinical studies identified by a Web of Science (R) search. Data were entered into decision analysis software (TreeAge (R) Pro 2009, Williamstown, MA, USA). Transition probabilities including the risk of death from complications or disease progression associated with individual therapy options were entered into the model. Sensitivity analysis was performed to evaluate the model's validity under a variety of assumptions.
Results : The result of the decision analysis confirms the superiority of the 'liver first' approach. Sensitivity analysis demonstrated that this assumption is valid on condition that the mortality associated with the hepatectomy first is <4.5%, and that the mortality of colectomy performed after hepatectomy is <3.2%.
Conclusion : The results of this decision analysis suggest that, in patients with synchronous resectable colorectal liver metastases, the 'liver first' approach is to be preferred. Randomized trials will be needed to confirm the results of this. simulation based outcome.},
  author       = {VAN DESSEL, ELS and FIERENS, KJELL and Pattyn, Piet and Van Nieuwenhove, Yves and Berrevoet, Frederik and Troisi, Roberto and Ceelen, Wim},
  issn         = {0001-5458},
  journal      = {ACTA CHIRURGICA BELGICA},
  keywords     = {CARCINOMA,HEPATIC METASTASES,DORMANCY,MANAGEMENT,ANGIOSTATIN,SURGERY,CHEMOTHERAPY,RESECTION,MODEL,PRIMARY TUMOR},
  language     = {eng},
  number       = {3},
  pages        = {317--320},
  publisher    = {ACTA MEDICAL BELGICA},
  title        = {Defining the Optimal Therapy Sequence in Synchronous Resectable Liver Metastases from Colorectal Cancer: A Decision Analysis Approach},
  volume       = {109},
  year         = {2009},
}

Web of Science
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