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
Ajith K. Siriwardena, Alejandro Serrablo, Åsmund Avdem Fretland, Stephen J. Wigmore, José Manuel Ramia, Hassan Malik, Stefan Stättner, Kjetil Søreide, Oded Zmora, Martijn R. Meijerink, Nikolaos Kartalis, Mickaël Lesurtel, Cornelis Verhoef, Anita Balakrishnan, Thomas Gruenberger, Eduard Jonas, John Devar, Saurabh Jamdar, Robert Jones, Mohammad Abu Hilal, Bodil Andersson, Karim Boudjéma, Saifee Mullamitha, Laurents Stassen, B. Dasari, Adam E. Frampton, Luca Aldrighetti, Gianluca Pellino, Pamela Buchwald, Bengı Gürses, Nir Wasserberg, Birgit Gruenberger, Harry Spiers, William R. Jarnagin, Jean‐Nicolas Vauthey, Norihiro Kokudo, Sabine Tejpar, Andrés Valdivieso, René Adam, Hauke Lang, Martin D. Smith, Michelle L. DeOliveira, Anya Adair, Stefan Gilg, Rutger‐Jan Swijnenburg, Joris Jaekers, Santhalingam Jegatheeswaran, Carlijn I. Buis, Rowan W. Parks, Maximilian Bockhorn, Thierry Conroy, Panagiotis Petras, Florian Primavesi, Anthony K.C. Chan, Federica Cipriani, Laura Rubbia‐Brandt, Lucy Foster, Amr Abdelaal, Sheraz Yaqub, Nuh N. Rahbari, Constantino Fondevila, M. Abradelo, Niels F.M. Kok, Luis Tejedor, Darío Martínez-Baena, Daniel Azoulay, Manuel Maglione, Mario Serradilla‐Martín, José Azevedo, Fabrizio Romano, Pål‐Dag Line, Teresa Abadía Forcén, Yves Panís, Nicolas Stylianides, Reto Bale, Emilio Quaia, Nuha Yassin, Victoria Duque, Eloy Espín, Jarno Mellenhorst, Adam Rees, Ademola Adeyeye, Jurriaan B. Tuynman, Constantinos Simillis, Sarah Duff, Richard Wilson, Paola De Nardi, Gabriella Jansson Palmer, Andee Dzulkarnaen Zakaria, Teresa Perra, Alberto Porcu, Nicolò Tamini, Michael E. Kelly, Islam H. Metwally, Ștefan Morărașu, Fabio Carbone, Mercedes Estaire-Gómez, Elena Martin Perez, Jennifer Seligmann, Simon Gollins
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.