Multidisciplinary treatment of liver metastasis from colorectal cancer to create novel evidences

Abstract

We discussed five points about colorectal liver metastases (CRLM) using answer pads. 1. Synchronous CRLM ≥5 cm was treated with upfront hepatectomy for 90% of patients; however liver-first approach was selected for approximately 10%. Staged operation was mainly performed for major hepatectomy and 67% of patients were received interval chemotherapy. 2. In patients with high-risk resectable CRLM, surgery alone for 69% of patients and surgery+postoperative chemotherapy for 31%; in low-risk CRLM, perioperative chemotherapy and surgery over 90% of patients were selected. 3. RAS and BRAF was measured in 77% and 9% of CRLM patients. In conversion therapy, oxaliplatin-based chemotherapy+targeted drugs was frequently used, especially FOLFOXIRI+ (bevacizumab) has been desirable. For assessment of tumor response, RECIST and/or early tumor shrinkage and deepness of response was commonly used. 4. For oncologically advanced CRLM patents being difficult to resect at one time, induction chemotherapy was performed for 79% of patients. One-step hepatectomy after portal embolization and two-step hepatectomy was selected for almost the same number, and ALPPS was for only 1% of patients. 5. New clinical trials were proposed; adjuvant chemotherapy using "FOLFOX+LV/UFT following hepatectomy for resectable CRLM", "perioperative chemotherapy depending on histological therapeutic effects for high-risk CRLM", and "surgery-first or primary-first for unresectable synchronous CRLM". With active discussion using answer pads, it was possible to consolidate the opinion of the gastroenterological surgeon at the present time and make recommendations for the future.