When you or your loved ones are diagnosed with colorectal cancer with liver metastasis, you need to have a liver surgeon in your treatment team. If you don’t, you need to find one. Many patients are treated by their medical oncology team without ever having a liver surgeon on board. This is a poor treatment strategy which no patients should have in modern 2022. A liver surgeon must be involved in order to produce the most optimal treatment outcomes and you will find in this article why.
In a recent Annals of Surgical Oncology journal publication by Vega et al, the critical role of a liver surgeon in the care of patients with colorectal cancer liver metastasis was examined. Lack of liver surgeon may lead to a failure to cure patients with potentially resectable (thus potentially cured) colorectal cancer with metastases to the liver. Dr. Sucandy has treated hundreds of patients with stage 4 colorectal cancer (especially those with liver metastasis) and has seen many patients are treated inadequately. This is especially true in Florida.
In many institutions or private oncology practices, especially those located in rural areas or outside a comprehensive liver program, the treatment of stage 4 colorectal cancer patients often do not include liver surgeons. This is caused by several factors. Lack of liver surgeon or liver specialist, poor understanding by medical oncologists that liver metastases can/should be resected and can be cured, or patient noncompliance. Often, the medical oncologists even made a wrong decision about patient’s ability/candidacy to have a surgical resection. This decision needs to be strictly made by a liver surgeon and not by a medical oncologist. Surgeon makes surgical decision based on his/her surgical experience and clinical evaluation. The goldstandard treatment team should include medical oncologist, liver surgeon, radiation oncologist, and interventional radiologist. All of these subspecialties are very important in ensuring optimum outcomes with liver surgeon being the most important specialist in resectable cases.
Vega et al found that 44% of patients who were assigned palliative chemotherapy at tumor board without a liver surgeon present are actually technically resectable and can undergo curative intent liver resection. This is a shocking discovery. The limit of liver surgery has increased with many new techniques such as 2 stage liver resection, portal vein embolization, ALPPS (Associating liver partition and portal vein ligation) to grow the other side of the liver, combination of liver resection + ablation, liver directed therapy followed by liver resection, robotic liver surgery, and many others. It is a major disadvantage for resectable patients to lose their potentials to be cured by liver surgery. There had been many studies that confirmed that resectable patients live much longer (years even decades) and at least 20% of them are cured altogether. “This can not be achieved without liver surgery, not even close” said Dr. Sucandy.
Finding an experienced liver surgeon also provides major advantages to patients. Criteria of surgical resectability may vary depending on the surgeon’s experience. An experienced liver surgeon can offer much more surgical options to patients when compared to unexperienced ones. Not all liver surgeon can offer robotic liver surgery. Even those who claim themselves robotic liver surgeons are not all the same in quality, techniques and outcomes. Dr. Sucandy is the leading robotic liver surgeon in the USA and world. At least 30% of his patients are coming from >200 miles away from Tampa, Florida. Many of them are also coming from other States. He has helped many of his colleagues in learning this technique but it takes time and dedication. Choose your best robotic liver surgeon for the best treatment outcomes.
Vega EA, Salehi O, Nicolaescu D, Dussom EM, Alarcon SV, Kozyreva O, Simonds J, Schnipper D, Conrad C. Failure to Cure Patients with Colorectal Liver Metastases: The Impact of the Liver Surgeon. Ann Surg Oncol. 2021 Nov;28(12):7698-7706. doi: 10.1245/s10434-021-10030-0. Epub 2021 Apr 30. Erratum in: Ann Surg Oncol. 2021 May 18;: PMID: 33939045.