The Oncosurge strategy for the management of colorectal liver metastases e An external validation study D.A. O’Reilly * , M. Chaudhari, M. Ballal, P. Ghaneh, A. Wu, G.J. Poston Department of Surgery, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK Accepted 21 April 2007 Available online 7 June 2007 Abstract Introduction: Because most patients with colorectal liver metastases (CRLM) present to general surgeons and oncologists without a special- ist interest in their management, a computer program (OncoSurge) has been created that identifies individual patient resectability and rec- ommends optimal treatment strategies. The aim of this study was to validate the Oncosurge strategy by comparing its recommendations with the decisions made by a multidisciplinary (MDT) meeting, in a supra-regional hepatobiliary referral centre, using real cases with known outcomes. Methods: We reviewed the records and imaging of 98 consecutive patients with CRLM, who had been referred for decision making to our MDT meeting between January 1, 2004 and December 31, 2004. All patient and tumour characteristics were entered onto the Oncosurge decision model, which was accessed at www.evidis.com/oncosurge/ Results: There was concordance between Oncosurge and MDT decisions in 93/98 cases. The observed kappa (k) was 0.850 (95% CI: 0.728e0.972). In descriptive terms, a kappa score greater than 0.8 equates to ‘‘almost perfect agreement’’. Conclusions: Our results demonstrate the validity of the Oncosurge system when compared to one year of decision making in an established hepatobiliary MDT meeting. This confirms the utility of the Oncosurge system for decision making, audit and educational purposes. Ó 2007 Elsevier Ltd. All rights reserved. Keywords: Colorectal liver metastases; OncoSurge; Multidisciplinary teams; Appropriateness criteria; Liver surgery Introduction The current management of colorectal liver metastases (CRLM) is complex and this is likely to become increas- ingly so in the future. 1e4 Multidisciplinary teams (MDT) are becoming increasingly common but are not yet ubiqui- tous. In order to exploit every opportunity to achieve cure, the management of CRLM should be undertaken in a multi- disciplinary setting, with a medical and surgical oncologist involved in the care of every patient. Because most patients with colorectal liver metastases present to general surgeons and oncologists without a specialist interest in their man- agement, a computer program (OncoSurge) has been cre- ated that identifies individual patient resectability and recommends optimal treatment strategies. 5 The RAND Corporation/University of California, Los Angeles Appro- priateness Method (RAM) was used to assess strategies of resection, local ablation and chemotherapy. After a compre- hensive literature review, an expert panel rated appropriate- ness of each treatment option for a total of 1872 ratings decisions in 252 cases. A decision model was constructed, consensus measured and results validated using 48 virtual cases, and 34 real cases with known outcomes. The aim of this study was to validate the Oncosurge strategy by comparing its recommendations with the deci- sions made by an MDT, in a hepatobiliary referral centre, using real cases with known outcomes. Patients and methods Patients We reviewed the records and imaging of 98 consecutive patients with CRLM, who had been referred for decision making to the MDT meeting of the Supra-Regional Hepatobiliary Centre, University Hospital Aintree, Liver- pool, UK, between January 1, 2004 and December 31, * Corresponding author. Tel.: þ44 151 529 85 78; fax: þ44 151 529 85 47. E-mail address: doreilly@doctors.org.uk (D.A. O’Reilly). 0748-7983/$ - see front matter Ó 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejso.2007.04.013 Available online at www.sciencedirect.com EJSO 34 (2008) 538e540 www.ejso.com