Evolution in the surgical management of colorectal liver metastases: Propensity score matching analysis (PSM) on the impact of specialized multidisciplinary care across two institutional eras

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorKRUGER, Jaime A. P.
dc.contributor.authorFONSECA, Gilton M.
dc.contributor.authorMAKDISSI, Fabio F.
dc.contributor.authorJEISMANN, Vagner B.
dc.contributor.authorCOELHO, Fabricio F.
dc.contributor.authorHERMAN, Paulo
dc.date.accessioned2018-11-21T17:01:28Z
dc.date.available2018-11-21T17:01:28Z
dc.date.issued2018
dc.description.abstractBackground and Objectives: Liver metastases are indicators of advanced disease in patients with colorectal cancer. Liver resection offers the best possibility of long-term survival. Surgical strategies have evolved in complexity in order to offer resection to a greater number of patients, requiring specialized multidisciplinary care. The current paper focused on analyzing outcomes of patients treated after the development of a dedicated cancer center in our institution. Methods: Patients operated on for CLM from our databank were paired through propensity score matching (PSM), and the initial experience of surgery for CLM was compared with the treatment performed after specialized multidisciplinary management. The demographic, oncological, and surgical features were analyzed between groups. Results: Overall, 355 hepatectomies were performed in 336 patients. Patients operated on during the second era of had greater use of preoperative chemotherapy (P<0.001) as well as exposure to more effective oxaliplatin-based regimens (P<0.001). Surgical management also changed, with minor (P=0.002) and non-anatomic (P=0.006) resections preferred over major operations. We also noted an increased number of minimally invasive resections (P<0.001). Conclusion: Treatment in a multidisciplinary cancer center led to changes in oncological and surgical management. Perioperative chemotherapy was frequently employed, and surgeons adopted a conservative approach to liver parenchyma.
dc.description.indexMEDLINE
dc.identifier.citationJOURNAL OF SURGICAL ONCOLOGY, v.118, n.1, p.50-60, 2018
dc.identifier.doi10.1002/jso.25098
dc.identifier.eissn1096-9098
dc.identifier.issn0022-4790
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/29453
dc.language.isoeng
dc.publisherWILEY
dc.relation.ispartofJournal of Surgical Oncology
dc.rightsrestrictedAccess
dc.rights.holderCopyright WILEY
dc.subjectchemotherapy
dc.subjectcolorectal cancer
dc.subjectliver metastases
dc.subjectparenchymal sparing
dc.subject.otherhepatic resection
dc.subject.othermultimodal treatment
dc.subject.otherbrazilian consensus
dc.subject.othernatural-history
dc.subject.othercancer
dc.subject.otherchemotherapy
dc.subject.othersurgery
dc.subject.otherhepatectomy
dc.subject.othersurvival
dc.subject.othercontroversies
dc.subject.wosOncology
dc.subject.wosSurgery
dc.titleEvolution in the surgical management of colorectal liver metastases: Propensity score matching analysis (PSM) on the impact of specialized multidisciplinary care across two institutional eras
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.citation.scopus12
hcfmusp.contributor.author-fmusphcJAIME ARTHUR PIROLA KRUGER
hcfmusp.contributor.author-fmusphcGILTON MARQUES FONSECA
hcfmusp.contributor.author-fmusphcFABIO FERRARI MAKDISSI
hcfmusp.contributor.author-fmusphcVAGNER BIRK JEISMANN
hcfmusp.contributor.author-fmusphcFABRICIO FERREIRA COELHO
hcfmusp.contributor.author-fmusphcPAULO HERMAN
hcfmusp.description.beginpage50
hcfmusp.description.endpage60
hcfmusp.description.issue1
hcfmusp.description.volume118
hcfmusp.origemWOS
hcfmusp.origem.pubmed29878362
hcfmusp.origem.scopus2-s2.0-85053277282
hcfmusp.origem.wosWOS:000444420200007
hcfmusp.publisher.cityHOBOKEN
hcfmusp.publisher.countryUSA
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