Postoperative surveillance after surgery for colorectal liver metastasis: a cross-sectional study

TL;DR

This study explores how doctors monitor patients after liver surgery for colorectal cancer spread, finding varied practices and a need for better evidence.

Contribution

The study reveals the lack of standardized surveillance protocols and surgeon uncertainty about their effectiveness.

Findings

Most UK centers follow up patients at six months, but practices vary at other intervals.

Surgeons consider factors like comorbidities and recurrence risk when personalizing surveillance.

There is uncertainty among clinicians about the true benefits versus costs of surveillance.

Abstract

Colorectal liver metastases (CRLM) are associated with a high recurrence rate after surgery. There is paucity of high-quality evidence regarding the nature and overall benefit of surveillance after hepatectomy for CRLM. As part of a broader programme of research, this study aimed to assess current strategies for surveillance after liver resection for CRLM and outline surgeons’ opinions regarding the benefit of postoperative surveillance.

An online survey was sent to clinicians performing surgery for CRLM at tertiary hepatobiliary centres in the UK.

There were responses from a total of 23 centres (88% response rate); 15/23 centres used standardised surveillance protocols for all patients. Most centres followed patients up at six months, but there is variation in postoperative surveillance at 3, 9, 18 and beyond 60 months. Patient comorbidities, indeterminate findings on imaging, margin status and assessment of recurrence risk were identified as the major factors influencing personalised surveillance strategies. There was clear clinician equipoise regarding the costs and benefits of surveillance.

There is heterogeneity in postoperative follow-up for CRLM in the UK. High-quality prospective studies and randomised trials are necessary to elucidate the value of postoperative surveillance and identify optimal follow-up strategies.

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