TY - JOUR
T1 - Managing synchronous liver metastases from colorectal cancer
T2 - A multidisciplinary international consensus
AU - of the EGOSLIM (Expert Group on OncoSurgery management of LIver Metastases) group
AU - Adam, René
AU - de Gramont, Aimery
AU - Figueras, Joan
AU - Kokudo, Norihiro
AU - Kunstlinger, Francis
AU - Loyer, Evelyne
AU - Poston, Graeme
AU - Rougier, Philippe
AU - Rubbia-Brandt, Laura
AU - Sobrero, Alberto
AU - Teh, Catherine
AU - Tejpar, Sabine
AU - Van Cutsem, Eric
AU - Vauthey, Jean Nicolas
AU - Påhlman, Lars
N1 - Publisher Copyright:
© 2015 The Authors.
PY - 2015/11
Y1 - 2015/11
N2 - 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.
AB - 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.
KW - Colorectal cancer
KW - Multidisciplinary team management
KW - Surgery
KW - Synchronous colorectal liver metastases
KW - Systemic therapy
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U2 - 10.1016/j.ctrv.2015.06.006
DO - 10.1016/j.ctrv.2015.06.006
M3 - Review article
C2 - 26417845
AN - SCOPUS:84944904298
SN - 0305-7372
VL - 41
SP - 729
EP - 741
JO - Cancer treatment reviews
JF - Cancer treatment reviews
IS - 9
ER -