Abstract:
PURPOSE:The optimal management of colorectal cancer liver metastases (CRC-LM) has changed during the past two decades. However, clinical practice lags behind best evidence recommendations. We sought to characterize the gap between current practice and best evidence for the management of these patients and to identify barriers that hamper effective utilization of metastasectomy. METHODS:A mixed-methods approach was used. A survey was mailed to all general surgeons (GS) and medical oncologists (MO) in Ontario, Canada. Domains examined included: physician/practice characteristics, indications for hepatectomy, use of multi-modality therapy and referral patterns. Physician focus groups were conducted that explored issues relating to access to care. RESULTS:The survey was mailed to 942 physicians with a response rate of 68 % (n = 348; GS n = 295, 69 %; MO n = 53, 63 %). Current practice patterns demonstrated that 97 % of physicians refer patients with low tumor burden (e.g., solitary CRC-LM), but referral rates for hepatectomy decreased as the tumor burden increased. Physicians still consider extrahepatic disease as a strong contraindication to metastasectomy. Barriers to care included: economic, time, and resource constraints; lack of physician engagement, local medical expertise, and high-quality guidelines. Multidisciplinary cancer conferences were identified as an enabler of clinical care and a potential platform for the acquisition of new medical knowledge. CONCLUSIONS:Current management of CRC-LM does not reflect best evidence. Patients who may benefit from surgery are not being referred for metastasectomy. We have identified an evidence-practice gap at the level of physician, which should be targeted with novel quality improvement strategies.
journal_name
Ann Surg Oncoljournal_title
Annals of surgical oncologyauthors
Wei AC,Sandhu L,Devitt KS,Gagliardi AR,Kennedy ED,Urbach DR,Gallinger S,Baxter NNdoi
10.1245/s10434-012-2698-3subject
Has Abstractpub_date
2013-05-01 00:00:00pages
1567-74issue
5eissn
1068-9265issn
1534-4681journal_volume
20pub_type
杂志文章abstract:BACKGROUND:Examination of pathology slides is a routine part of a breast cancer second opinion. The purpose of this study was to determine how often the pathologic second opinion (1) altered the diagnosis and (2) resulted in a change in the surgical procedure. METHODS:Patients presenting between 1997 and 2001 for a se...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1007/BF02574516
更新日期:2002-12-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to establish and validate an individualized nomogram for predicting disease-specific survival (DSS) in patients with non-metastatic ampullary carcinoma after surgery. METHODS:The nomogram was prepared using retrospective data from the Surveillance, Epidemiology, and End Results data...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-018-07115-8
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:International consensus criteria (ICC) have redefined borderline resectability for pancreatic ductal adenocarcinoma (PDAC) according to three dimensions: anatomical (BR-A), biological (BR-B), and conditional (BR-C). The present definition acknowledges that resectability is not just about the anatomic relatio...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-020-09100-6
更新日期:2020-09-12 00:00:00
abstract:BACKGROUND:The purpose of this study was to evaluate postoperative pain and postoperative nausea and vomiting (PONV) in patients with paravertebral blocks (PVB) undergoing breast cancer surgery with or without axillary staging. METHODS:An Institutional Review Board approved, retrospective chart review from January 200...
journal_title:Annals of surgical oncology
pub_type: 临床试验,杂志文章
doi:10.1245/s10434-011-1899-5
更新日期:2012-02-01 00:00:00
abstract:OBJECTIVES:To reject the hypothesis that the number of nodes removed at time of surgical staging for vulva cancer is not an important prognostic factor. METHODS:Retrospective chart reviews were carried out from 1980-2004 to identify patients with squamous cell vulva carcinoma treated with radical vulvectomy and bilate...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-007-9417-5
更新日期:2007-07-01 00:00:00
abstract:BACKGROUND:Near-infrared (NIR) fluorescent sentinel lymph node (SLN) mapping in breast cancer requires optimized imaging systems and lymphatic tracers. MATERIALS AND METHODS:A small, portable version of the FLARE imaging system, termed Mini-FLARE, was developed for capturing color video and two semi-independent channe...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-011-1566-x
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:Although many experiences using the da Vinci Robot System have been reported by several groups, there is substantial controversy over the role of the robot in thyroidectomy. We performed a systematic review and meta-analyses in order to evaluate the safety and effectiveness of robotic thyroidectomy (RT) comp...
journal_title:Annals of surgical oncology
pub_type: 杂志文章,meta分析,评审
doi:10.1245/s10434-015-4375-9
更新日期:2015-09-01 00:00:00
abstract:: ...
journal_title:Annals of surgical oncology
pub_type: 社论
doi:10.1245/s10434-018-7036-y
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Limited data are available on the use of cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (HIPEC) in patients with recurrent stage III ovarian cancer. METHODS:Patients with recurrent, heavily pretreated ovarian cancer were enrolled onto a phase II multimodal protocol consisting of exte...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-009-0878-6
更新日期:2012-07-01 00:00:00
abstract:PURPOSE:The aim of this study is to evaluate the safety and efficacy of induction modified 5-fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) plus bevacizumab followed by S- 1-based chemoradiotherapy in magnetic resonance imaging (MRI)-defined poor-risk locally advanced low rectal cancer. PATIENTS AND METHODS:This...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-019-07342-7
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:The risk factors and incidence of venous thromboembolism (VTE) are not well defined in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). We sought to characterize the incidence, risk factors, and pharmacothromboprophylaxis strategies for VTE after CRS/HIPEC....
journal_title:Annals of surgical oncology
pub_type: 临床试验,杂志文章
doi:10.1245/s10434-019-07414-8
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:Despite advances in the treatment of patients with gastric cancer, the debate over the optimal extent of lymphadenectomy continues. METHOD:A review of the classification, rationale for, and boundaries of lymphadenectomy is presented. A review of the available literature comparing D1 versus D2 versus D3 lymp...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-019-07417-5
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:There is a continuous interest in the literature concerning the management and survival after treatment of local recurrence in sarcomas because it is one of the most common types of recurrence. DESIGN:We retrospectively reviewed 93 patients treated for local recurrence from soft-tissue sarcoma. METHODS:We ...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1007/BF02306280
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:Histologic grade, TNM stage, and Nottingham Prognostic Index are traditional prognostic tools for breast cancer. "IHC-molecular" classification of breast cancer can also identify patients at different recurrence risks and provides insight into cancer therapy. However, cancers in each group are heterogeneous....
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-014-3691-9
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:In a Dutch phase II trial conducted between 2006 and 2010, short-course radiotherapy followed by systemic therapy with capecitabine, oxaliplatin, and bevacizumab as neoadjuvant treatment and subsequent radical surgical treatment of primary tumor and metastatic sites was evaluated. In this study, we report th...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-017-5897-0
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:The enhanced esthetics and demonstrated oncologic safety of nipple-sparing mastectomy (NSM) in selected patients have resulted in increased rates among patients with locally advanced breast cancer and/or additional risk factors (obesity, prior radiation, surgery). Limited data exist on complication and recon...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-019-07560-z
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND/OBJECTIVE:The efficacy of chemoprevention for breast cancer risk reduction has been demonstrated in randomized controlled trials; however, use remains low. We sought to determine whether uptake differed by risk factors, and to identify reasons for refusal and termination. METHODS:Women seen in a high-risk c...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-019-07236-8
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:The usefulness of enteral nutrition via a nasointestinal tube for patients who develop postoperative pancreatic fistula (POPF) after miscellaneous pancreatectomy procedures has been reported. However, no clear evidence regarding whether oral intake is possible during management of POPF after pancreatoduodene...
journal_title:Annals of surgical oncology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1245/s10434-015-4496-1
更新日期:2015-11-01 00:00:00
abstract:BACKGROUND:High-grade (HG) mucinous appendiceal neoplasms (MAN) have a worse prognosis than low-grade histology. Our objective was to assess the safety and efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) in patients with high-grade, high-volume (HG-HV) peritoneal metastase...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-015-4838-z
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:Survival for Child's A patients with hepatocellular cancer (HCC) and macroscopic vascular invasion (MVI) has been reported as approximately 8.1 months with sorafenib. The role of surgery for these patients remains controversial. METHODS:The records of all patients undergoing resection of HCC at a single cen...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-013-3074-7
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:Metastatic breast cancer is an aggressive disease associated with recurrence and decreased survival. To improve outcomes and develop more effective treatment strategies for patients with breast cancer, it is important to understand the molecular mechanisms underlying metastasis. METHODS:We used allelic imba...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-008-9815-3
更新日期:2008-04-01 00:00:00
abstract:BACKGROUND:The quality of decision-making in cancer multidisciplinary team (MDT) meetings is variable, which can result in suboptimal clinical decision making. We developed MDT-QuIC, an evidence-based tool to support clinical decision making by MDTs, which was evaluated by key users. METHODS:Following a literature rev...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-011-2187-0
更新日期:2012-06-01 00:00:00
abstract:: ...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-018-6645-9
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:A recent study showed that circulating exosomal PD-L1 is an effective predictor for anti-PD-1 therapy in melanomas. Exosomal PD-L1 induced immunosuppression microenvironments in cancer patients. However, its prognostic value and immunosuppressive effect in gastric cancer (GC) were poorly understood. METHODS...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-019-07431-7
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Laparoscopic liver resection (LLR) for large malignant tumors can be technically challenging. Data on this topic are scarce, and many question its feasibility, safety, and oncologic efficiency. This study aimed to assess outcomes of LLR for large (≥ 5 cm) and giant (≥ 10 cm) malignant liver tumors. METHODS:...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-014-4107-6
更新日期:2015-04-01 00:00:00
abstract:PURPOSE:To determine whether satisfaction and health-related quality of life (HR-QoL) differ between women who do and do not undergo contralateral prophylactic mastectomy (CPM) in the setting of implant reconstruction using the BREAST-Q, a validated patient-reported outcome instrument. METHODS:From 2000 to 2007, a tot...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-013-3026-2
更新日期:2013-10-01 00:00:00
abstract:INTRODUCTION:In adrenal tumors, size ≥ 4 cm has been an indication for adrenalectomy due to concern for malignancy. We compared mass size to imaging features (ImF) for accuracy in diagnosing adrenal malignancy. METHODS:Data were retrieved for 112 consecutive patients who had adrenalectomy from January 2011 to August 2...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-015-4684-z
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Recently, it was reported that minimally invasive surgery (MIS) has a negative impact on early-stage cervical cancer (ECC) patient survival. At the same time, advantages of MIS regarding quality of life and low rate of intra- and postoperative complications are well known. Therefore, it is essential to selec...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-019-08162-5
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:There is conflicting evidence concerning platelet status and hepatocellular carcinoma (HCC) prognosis. We evaluated the prognostic value of platelet-based indices, including platelet count, platelet/lymphocyte ratio (PLR), and aspartate aminotransferase to platelet ratio index (APRI) in HCC after hepatic res...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-014-3771-x
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:The role neoadjuvant chemoradiotherapy (nCRT) plays in oncological outcomes in early T-stage rectal cancer is uncertain. The present work aims to clarify prognostic outcomes by estimating the effect of nCRT on tumor recurrence prior to major surgery compared with major surgery alone. PATIENTS AND METHODS:Pr...
journal_title:Annals of surgical oncology
pub_type: 杂志文章,多中心研究
doi:10.1245/s10434-019-08105-0
更新日期:2020-05-01 00:00:00