The multi-societal 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

Siriwardena AK 1 , Serrablo A 2 , Fretland ÅA 3 , Wigmore SJ 4 , Ramia-Angel JM 5 , Malik HZ 6 Show all authors , Stättner S 7 , Søreide K 8 , Zmora O 9 , Meijerink M 10 , Kartalis N 11 , Lesurtel M 12 , Verhoef C 13 , Balakrishnan A 14 , Gruenberger T 15 , Jonas E 16 , Devar J 17 , Jamdar S 18 , Jones R 6 , Hilal MA 19 , Andersson B 20 , Boudjema K 21 , Mullamitha S 22 , Stassen L 23 , Dasari BVM 24 , Frampton AE 25 , Aldrighetti L 26 , Pellino G 27 , Buchwald P 20 , Gürses B 28 , Wasserberg N 29 , Gruenberger B 30 , Spiers HVM 14 , Jarnagin W 31 , Vauthey JN 32 , Kokudo N 33 , Tejpar S 34 , Valdivieso A 35 , Adam R 36 , Joint E-AHPBA/ESSO/ESCP/ESGAR/CIRSE 2022 Consensus on colorectal cancer with synchronous liver metastases

Affiliations 

  • 1 Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK. Electronic address: ajith.siriwardena@mft.nhs.uk
  • 2 Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
  • 3 Department of Surgery, Oslo University Hospital, Oslo, Norway
  • 4 Hepatobiliary and Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
  • 5 Department of Surgery, University Hospital of Guadalajara, Guadalajara, Spain
  • 6 Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
  • 7 Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum, Vöcklabruck, Austria
  • 8 Department of Surgery, Bergen University Hospital, Bergen, Norway
  • 9 Department of Colorectal Surgery, Shamir Medical Center, Tel Aviv, Israel
  • 10 Department of Radiology, Amsterdam University Medical Center, Amsterdam, Netherlands
  • 11 Department of Radiology, Karolinska Institutet, Stockholm, Sweden
  • 12 Department of Surgery, Beaujon Hospital, Clichy, France
  • 13 Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
  • 14 Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke's Hospital, Cambridge, UK
  • 15 Department of Surgery, HPB Center, Health Network Vienna, Clinic Favoriten and Sigmund Freud University, Vienna, Austria
  • 16 Department of Surgery, Groote Schuur Hospital, Cape Town
  • 17 Department of Surgery, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
  • 18 Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
  • 19 Department of Surgery, Poliambulanza Hospital, Brescia, Italy
  • 20 Department of Surgery, Skane University Hospital, Lund, Sweden
  • 21 Department of Hepatobiliary, Pancreatic and Digestive Surgery, Hôpital Pontchaillou, Rennes, France
  • 22 Oncology Department, Christie Hospital, Manchester, UK
  • 23 Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
  • 24 Hepatobiliary and Liver Transplant Unit, Queen Elizabeth University Hospital, Birmingham, UK
  • 25 Hepato-Pancreato-Biliary Unit, Royal Surrey County Hospital, Guildford, UK
  • 26 Department of Surgery, Vita Salute San Raffaele University & IRCCS San Raffaele Hospital, Milan, Italy
  • 27 Department of Colorectal Surgery, Vall D'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
  • 28 Department of Radiology, Koc University Medical Faculty, Istanbul, Turkey
  • 29 Department of Surgery, Beilinson Hospital, Rabin Medical Center, Tel Aviv University, Israel
  • 30 Department of Medical Oncology and Haematology, Landesklinikum Wiener Neustadt, Lower Austria, Austria
  • 31 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
  • 32 Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA
  • 33 Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
  • 34 Department of Oncology, UZ Leuven, Leuven, Belgium
  • 35 HPB Surgery and Liver Transplant, HU Cruces, Bilbao, Spain
  • 36 Hepatobiliary and Transplant Unit, Hôpital Paul Brousse, Paris, France
HPB (Oxford), 2023 Sep;25(9):985-999.
PMID: 37471055 DOI: 10.1016/j.hpb.2023.05.360

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 multi-organisational, 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% 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 twelve 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 with "late metachronous metastases" applied to those detected after 12 months. Disappearing metastases applies to lesions which are no longer detectable on MR scan 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.

CONCLUSIONS: The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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