SAGES/AHPBA guidelines for the use of minimally invasive surgery for the surgical treatment of colorectal liver metastases (CRLM)
Authors
Timothy J. Vreeland, Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA.
Amelia T. Collings, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.Follow
Ahmad Ozair, Faculty of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
Alexandra M. Adams, Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA.Follow
Rebecca Dirks, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Bradley S. Kushner, Washington University School of Medicine, St. Louis, MO, USA.
Iswanto Sucandy, Digestive Health Institute, AdventHealth Tampa, FL, USA.
David Morrell, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Jake Whiteside, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Mohammed T. Ansari, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.Follow
Jordan Cloyd, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Sean P. Cleary, Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Eugene Ceppa, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.Follow
Ahmed M. Abou-Setta, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.Follow
Adnan Alseidi, Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
Ziad Awad, Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
Subhashini Ayloo, Alpert Medical School of Brown University, Providence, RI, USA.Follow
Joseph Buell, Division of Surgery, Mission Healthcare System, HCA Healthcare, Asheville, NC, USA.Follow
Georgios Orthopoulos, Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Worcester, USA.
William Richardson, Section of General Surgery, Oschner Clinic, New Orleans, LA, USA.
Samer Sbayi, Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
Go Wakabayashi, Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Department of Surgery, Ageo Central General Hospital, Ageo City, Japan.
Horacio Asbun, Baptist Health Miami Cancer Institute, Miami, FL, USA.
Bethany J. Slater, Advocate Aurora HealthFollow
Aurora D. Pryor, Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
Recommended Citation
Vreeland TJ, Collings AT, Ozair A, et al. SAGES/AHPBA guidelines for the use of minimally invasive surgery for the surgical treatment of colorectal liver metastases (CRLM). Surg Endosc. 2023;37(4):2508-2516. doi:10.1007/s00464-023-09895-x
Abstract
Background: Colorectal liver metastases (CRLM) occur in roughly half of patients with colorectal cancer. Minimally invasive surgery (MIS) has become an increasingly acceptable and utilized technique for resection in these patients, but there is a lack of specific guidelines on the use of MIS hepatectomy in this setting. A multidisciplinary expert panel was convened to develop evidence-based recommendations regarding the decision between MIS and open techniques for the resection of CRLM.
Methods: Systematic review was conducted for two key questions (KQ) regarding the use of MIS versus open surgery for the resection of isolated liver metastases from colon and rectal cancer. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Additionally, the panel developed recommendations for future research.
Results: The panel addressed two KQs, which pertained to staged or simultaneous resection of resectable colon or rectal metastases. The panel made conditional recommendations for the use of MIS hepatectomy for both staged and simultaneous resection when deemed safe, feasible, and oncologically effective by the surgeon based on the individual patient characteristics. These recommendations were based on low and very low certainty of evidence.
Conclusions: These evidence-based recommendations should provide guidance regarding surgical decision-making in the treatment of CRLM and highlight the importance of individual considerations of each case. Pursuing the identified research needs may help further refine the evidence and improve future versions of guidelines for the use of MIS techniques in the treatment of CRLM.
