Is it possible to cure patients with unresectable colorectal liver metastases? Are complex surgeries safe for patients with extensive metastatic disease? How can we monitor and improve the quality of these surgical strategies? How can we improve surgical care for patients through research?
These are all pressing questions, and EORTC trial 1409 CLIMB, A Prospective Colorectal Liver Metastasis DataBase with an Integrated Quality Assurance program, the first collaborative project of the EORTC and ESSO (European Society of Surgical Oncology) now provides a much needed opportunity to do a prospective study for liver metastasis surgery.
Colorectal cancer is the second most common cause of all cancer deaths in Europe, and despite early detection programs about one fourth of all patients have synchronous metastasis at the time of diagnosis, and up to one half of all patients will develop metastasis after initial surgery. Despite the advancement in knowledge for colorectal cancer, we still lack high quality prospective studies on surgery for complex cases in this field.
Prof. Serge Evrard, Head of the Digestive Tumours Unit at Institut Bergonié, ESSO Clinical Research Director, and Coordinator of CLIMB says, “The benefits of surgery and radiofrequency ablation have been demonstrated in the CLOCC trial (EORTC 40004) for unresectable liver metastasis. Since then, the limits of resectability and treatment options for those with extensive liver metastasis and even for extra-hepatic disease have greatly expanded. It is a difficult task to do a prospective and multi-center study to evaluate these strategies but EORTC and ESSO have taken on this challenge.”
CLIMB will include all patients with colorectal adenocarcinoma with complex and unresectable metastasis (liver and extra-hepatic) who are potential candidates for a surgical procedure as evaluated by a multi-disciplinary team before any treatment.
Prof. Graeme Poston, Consultant Hepato-biliary Surgeon at University Hospital Aintree Hepatobiliary Center in Liverpool, ESSO Past-President, and Co-coordinator of CLIMB says, “This is a complex group of patients for whom a multi-disciplinary approach is required. We will evaluate the complications from different surgical strategies and set thresholds for improving the quality of surgical care for our patients.”
As it is the pilot study of a surgical quality assurance program of EORTC and ESSO, CLIMB will be an opportunity to demonstrate how real-life clinical data obtained through the quality assurance process of EORTC can improve surgical oncology research and the delivery of care for patients. It will aim to accrue at least 100 post-operative patients from 12 countries: Austria, Belgium, Denmark, France, Germany, Italy, Norway, Spain, Sweden, Switzerland, The Netherlands, and the United Kingdom. All centers conduct highly specialized and multi-disciplinary team management for complex cases of liver metastasis. An academic study of this scale is only feasible through the partnership of EORTC and ESSO. Globally, there is a huge deficit in prospective and high quality surgical oncology research and more public support is urgently needed not just to increase quantity of research but also to improve the quality of surgery for our cancer patients.
This trial is coordinated by the EORTC Gastrointestinal Group and supported by the EORTC Academic Fund and the ESSO Clinical Research Fund. For more information about the study, please contact email@example.com.
John Bean, PhD
EORTC, Medical Science Writer