Ajith K Siriwardena, Alejandro Serrablo, Åsmund Avdem Fretland, Stephen J Wigmore, Jose Manuel Ramia-Angel, Hassan Z Malik, Stefan Stättner, Kjetil Søreide, Oded Zmora, Martijn Meijerink, Nikolaos Kartalis, Mickaёl Lesurtel, Kees Verhoef, Anita Balakrishnan, Thomas Gruenberger, Eduard Jonas, John Devar, Saurabh Jamdar, Robert Jones, Mohammad Abu Hilal, Bodil Andersson, Karim Boudjema, Saifee Mullamitha, Laurents Stassen, Bobby V M Dasari, Adam E Frampton, Luca Aldrighetti, Gianluca Pellino, Pamela Buchwald, Bengi Gürses, Nir Wasserberg, Birgit Gruenberger, Harry V M Spiers, William Jarnagin, Jean-Nicholas Vauthey, Norihiro Kokudo, Sabine Tejpar, Andres Valdivieso, René Adam

Multisocietal European consensus on the terminology, diagnosis, and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE

  • Surgery
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Abstract Background Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases, with a focus on terminology, diagnosis, and management. Methods This project was a multiorganizational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis, and management. Statements were refined during an online Delphi process, and those with 70 per cent agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising 12 key statements. Results Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term ‘early metachronous metastases' applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour, the term ‘late metachronous metastases’ applies to those detected after 12 months. ‘Disappearing metastases’ applies to lesions that are no longer detectable on MRI after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards, and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways, including systemic chemotherapy, synchronous surgery, and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed. Conclusion The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.

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