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Management of colorectal cancer presenting with synchronous liver metastases

Lookup NU author(s): Professor James Mason, Professor Helen Hancock


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Up to a fifth of patients with colorectal cancer (CRC) present with synchronous hepatic metastases. In patients with CRC who present without intestinal obstruction or perforation and in whom comprehensive whole-body imaging confirms the absence of extrahepatic disease, evidence indicates a state of equipoise between several different management pathways, none of which has demonstrated superiority. Neoadjuvant systemic chemotherapy is advocated by current guidelines, but must be integrated with surgical management in order to remove the primary tumour and liver metastatic burden. Surgery for CRC with synchronous liver metastases can take a number of forms: the 'classic' approach, involving initial colorectal resection, interval chemotherapy and liver resection as the final step; simultaneous removal of the liver and bowel tumours with neoadjuvant or adjuvant chemotherapy; or a 'liver-first' approach (before or after systemic chemotherapy) with removal of the colorectal tumour as the final procedure. In patients with rectal primary tumours, the liver-first approach can potentially avoid rectal surgery in patients with a complete response to chemoradiotherapy. We overview the importance of precise nomenclature, the influence of clinical presentation on treatment options, and the need for accurate, up-to-date surgical terminology, staging tests and contemporary management options in CRC and synchronous hepatic metastatic disease, with an emphasis on multidisciplinary care. © 2014 Macmillan Publishers Limited. All rights reserved.

Publication metadata

Author(s): Siriwardena AK, Mason JM, Mullamitha S, Hancock HC, Jegatheeswaran S

Publication type: Review

Publication status: Published

Journal: Nature Reviews Clinical Oncology

Year: 2014

Volume: 11

Issue: 8

Pages: 446-459

Online publication date: 03/06/2014

Acceptance date: 01/01/1900

ISSN (print): 1759-4774

ISSN (electronic): 1759-4782

Publisher: Nature Publishing Group


DOI: 10.1038/nrclinonc.2014.90

PubMed id: 24889770