title: Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus.
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.
authors.affiliation: AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France. Electronic address: rene.adam@pbr.aphp.fr.
authors.forename: René
authors.initials: R
authors.lastname: Adam
authors.affiliation: Franco-British Institute, Levallois-Perret, France. Electronic address: aimerydegramont@gmail.com.
authors.forename: Aimery
authors.initials: A
authors.lastname: de Gramont
authors.affiliation: 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.
authors.forename: Joan
authors.initials: J
authors.lastname: Figueras
authors.affiliation: 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.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.affiliation: AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Villejuif, France. Electronic address: kunstfrancis@gmail.com.
authors.forename: Francis
authors.initials: F
authors.lastname: Kunstlinger
authors.affiliation: Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA. Electronic address: eloyer@mdanderson.org.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Loyer
authors.affiliation: Surgery Department, Aintree University Hospital, School of Translational Studies, University of Liverpool, Liverpool, UK. Electronic address: Graeme.poston@aintree.nhs.uk.
authors.forename: Graeme
authors.initials: G
authors.lastname: Poston
authors.affiliation: Digestive Oncology Department, Hôpital Européen Georges Pompidou, University Paris V-René Descartes and AP-HP Paris, France. Electronic address: rougier.philippe2012@gmail.com.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rougier
authors.affiliation: Pathology Department, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland. Electronic address: laura.rubbia-brandt@hcuge.ch.
authors.forename: Laura
authors.initials: L
authors.lastname: Rubbia-Brandt
authors.affiliation: Medical Oncology, IRCCS San Martino IST, Genoa, Italy. Electronic address: alberto.sobrero@hsanmartino.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Sobrero
authors.affiliation: Liver Centre and Department of Surgery, National Kidney & Transplant Institute, Quezon City, Philippines. Electronic address: drcteh@me.com.
authors.forename: Catherine
authors.initials: C
authors.lastname: Teh
authors.affiliation: Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium. Electronic address: sabine.tejpar@med.kuleuven.be.
authors.forename: Sabine
authors.initials: S
authors.lastname: Tejpar
authors.affiliation: Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium. Electronic address: eric.vancutsem@uzleuven.be.
authors.forename: Eric
authors.initials: E
authors.lastname: Van Cutsem
authors.affiliation: Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA. Electronic address: jvauthey@mdanderson.org.
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.affiliation: Department of Surgical Science, Uppsala University Hospital, Uppsala, Sweden. Electronic address: lars.pahlman@surgsci.uu.se.
authors.forename: Lars
authors.initials: L
authors.lastname: Påhlman
mesh_terms: D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic
keywords: Colorectal cancer; Multidisciplinary team management; Surgery; Synchronous colorectal liver metastases; Systemic therapy