CoSMIC: Colorectal ca & Synchronous liver Metastases Inception Cohort.
Research type
Research Study
Full title
Colorectal cancer with Synchronous liver-limited Metastases: an Inception Cohort study of standardised care pathways (CoSMIC).
IRAS ID
158568
Contact name
Ajith Siriwardena
Contact email
Sponsor organisation
Central Manchester University Hospital NHS Foundation Trust
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Bowel cancer is the fourth most common cancer in the UK. In 20% of patients, bowel cancer has already spread when it is diagnosed. The disease is ‘synchronous’ when found in several places at first diagnosis. If the cancer has spread beyond the liver, only 6% of patients live more than 5 years following their diagnosis, but for patients with metastatic disease limited to the liver, surgery can improve 5-year survival to 25-40%.
The approach to surgery for patients with synchronous disease is complex. In conventional surgery, the bowel cancer is removed first, followed by chemotherapy and then surgery to remove the liver metastasis. With advances in Surgery, two other options have become possible. Synchronous surgery removes the bowel cancer and liver metastasis together in one major operation. Liver-first surgery removes the liver metastasis first as this is thought to be the source of cancer that spreads, and then the bowel cancer.
Currently, there is little evidence showing which approach is better. Thus, there is no established treatment protocol or pathway. The care of each patient is discussed amongst specialist doctors at multidisciplinary team meetings. Treatment options offered depend on a multitude of factors: aspects of the cancer, patient health and wishes, and clinical experience.
This study, called ‘Colorectal cancer with Synchronous liver-limited hepatic Metastasis: an Inception Cohort’ (CoSMIC), will identify patients newly diagnosed with bowel cancer and liver-limited synchronous disease, and seek their consent to record the care they receive. The sequence of treatment and reasons why it was chosen, as well as patients’ quality of life and cancer outcome will be recorded. The study will recruit patients for two years at Manchester Royal Infirmary. Study findings are essential to developing evidence for the optimal management of synchronous bowel-liver disease.
REC name
North West - Greater Manchester Central Research Ethics Committee
REC reference
14/NW/1397
Date of REC Opinion
19 Nov 2014
REC opinion
Further Information Favourable Opinion