Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

René Adam, Aimery de Gramont, Joan Figueras, Norihiro Kokudo, Francis Kunstlinger, Evelyne Loyer, Graeme Poston, Philippe Rougier, Laura Rubbia-Brandt, Alberto Sobrero, Catherine Teh, Sabine Tejpar, Eric Van Cutsem, Jean Nicolas Vauthey, Lars Påhlman

Research output: Contribution to journalArticle

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 ≤12. months and >12. months 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.

Original languageEnglish
Pages (from-to)729-741
Number of pages13
JournalCancer Treatment Reviews
Volume41
Issue number9
DOIs
Publication statusPublished - Nov 1 2015

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

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  • Cite this

    Adam, R., de Gramont, A., Figueras, J., Kokudo, N., Kunstlinger, F., Loyer, E., Poston, G., Rougier, P., Rubbia-Brandt, L., Sobrero, A., Teh, C., Tejpar, S., Van Cutsem, E., Vauthey, J. N., & Påhlman, L. (2015). Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus. Cancer Treatment Reviews, 41(9), 729-741. https://doi.org/10.1016/j.ctrv.2015.06.006