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Cancer Treat Rev. 2015 Nov;41(9):729-41. doi: 10.1016/j.ctrv.2015.06.006. Epub 2015 Jun 30.

Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus.

Author information

1
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France. Electronic address: rene.adam@pbr.aphp.fr.
2
Franco-British Institute, Levallois-Perret, France. Electronic address: aimerydegramont@gmail.com.
3
Hepato-biliary and Pancreatic Surgery Unit, Department of Surgery, Dr Josep Trueta Hospital, Institut d'Investigació Biomèdica (IDIBGi), Girona, Spain. Electronic address: info@jfigueras.net.
4
Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, University of Tokyo, Tokyo, Japan. Electronic address: KOKUDO-2SU@h.u-tokyo.ac.jp.
5
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France. Electronic address: kunstfrancis@gmail.com.
6
Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA. Electronic address: eloyer@mdanderson.org.
7
Surgery Department, Aintree University Hospital, School of Translational Studies, University of Liverpool, Liverpool, UK. Electronic address: Graeme.poston@aintree.nhs.uk.
8
Digestive Oncology Department, Hôpital Européen Georges Pompidou, University Paris V-René Descartes and AP-HP Paris, France. Electronic address: rougier.philippe2012@gmail.com.
9
Pathology Department, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland. Electronic address: laura.rubbia-brandt@hcuge.ch.
10
Medical Oncology, IRCCS San Martino IST, Genoa, Italy. Electronic address: alberto.sobrero@hsanmartino.it.
11
Liver Centre and Department of Surgery, National Kidney & Transplant Institute, Quezon City, Philippines. Electronic address: drcteh@me.com.
12
Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium. Electronic address: sabine.tejpar@med.kuleuven.be.
13
Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium. Electronic address: eric.vancutsem@uzleuven.be.
14
Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA. Electronic address: jvauthey@mdanderson.org.
15
Department of Surgical Science, Uppsala University Hospital, Uppsala, Sweden. Electronic address: lars.pahlman@surgsci.uu.se.

Abstract

An international panel of multidisciplinary experts convened to develop recommendations for managing patients with colorectal cancer (CRC) and synchronous liver metastases (CRCLM). A modified Delphi method was used. CRCLM is defined as liver metastases detected at or before diagnosis of the primary CRC. Early and late metachronous metastases are defined as those detected ⩽12months and >12months after surgery, respectively. To provide information on potential curability, use of high-quality contrast-enhanced computed tomography (CT) before chemotherapy is recommended. Magnetic resonance imaging is increasingly being used preoperatively to aid detection of subcentimetric metastases, and alongside CT in difficult situations. To evaluate operability, radiology should provide information on: nodule size and number, segmental localization and relationship with major vessels, response after neoadjuvant chemotherapy, non-tumoral liver condition and anticipated remnant liver volume. Pathological evaluation should assess response to preoperative chemotherapy for both the primary tumour and metastases, and provide information on the tumour, margin size and micrometastases. Although the treatment strategy depends on the clinical scenario, the consensus was for chemotherapy before surgery in most cases. When the primary CRC is asymptomatic, liver surgery may be performed first (reverse approach). When CRCLM are unresectable, the goal of preoperative chemotherapy is to downsize tumours to allow resection. Hepatic resection should not be denied to patients with stable disease after optimal chemotherapy, provided an adequate liver remnant with inflow and outflow preservation remains. All patients with synchronous CRCLM should be evaluated by a hepatobiliary multidisciplinary team.

KEYWORDS:

Colorectal cancer; Multidisciplinary team management; Surgery; Synchronous colorectal liver metastases; Systemic therapy

PMID:
26417845
DOI:
10.1016/j.ctrv.2015.06.006
[Indexed for MEDLINE]
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