Colorectal Liver Metastases Resectability Assessment
Colorectal Liver Metastases Resectability Assessment: Colorectal Liver Metastases Diagnosed → Complete Staging → Technical Resectability → Technically R...
Interactive Decision Tree
Algorithm Steps
- ▶Start
Colorectal Liver Metastases Diagnosed
Imaging-confirmed liver-limited or oligometastatic disease
- ●Action
Complete Staging
CT C/A/P, PET-CT, liver MRI
- Confirm liver-limited (or limited extrahepatic)
- Assess primary tumor status
- RAS/BRAF mutation status
- ◆Decision
Technical Resectability
- R0 resection achievable?
- FLR >20-30% (>40% if chemo)
- Adequate vascular inflow/outflow
- ≥2 contiguous segments preserved
- ●Action
Technically Resectable
Upfront surgery or neoadjuvant
- ◆Decision
Oncologic Risk Assessment
- CRS (Fong) or GAME score
- Node+, CEA >200, >1 tumor, size >5cm
- DFI <12 months, extrahepatic disease
- ●Action
Low Risk
Consider upfront resection
- Synchronous: staged or simultaneous
- Metachronous: resection
- ●Action
Hepatic Resection
Parenchymal-sparing preferred
- Anatomic or wedge resection
- Laparoscopic if feasible
- R0 resection goal
- ■End
Adjuvant Therapy & Surveillance
Complete periop chemo, imaging surveillance
- ●Action
High Risk
Neoadjuvant chemotherapy
- FOLFOX/FOLFIRI ± targeted
- Assess response before surgery
- Test tumor biology
- ●Action
Borderline Resectable
May become resectable
- ●Action
Conversion Strategy
Intensive chemotherapy
- FOLFOXIRI + bevacizumab
- Reassess q8 weeks
- Liver-directed therapy (Y90, SBRT)
- ●Action
Palliation/Systemic
If remains unresectable
- ●Action
FLR Augmentation
If insufficient FLR
- PVE (portal vein embolization)
- Two-stage hepatectomy
- ALPPS if needed
- ●Action
Unresectable
Conversion therapy needed
Guideline Source
AHPBA Consensus Guidelines on Colorectal Liver Metastases
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Resectability criteria have expanded - MDT essential
- Biologic factors (RAS, timing, response to chemo) matter
- Two-stage hepatectomy and ALPPS expand resectability
- Liver-directed therapy for unresectable can convert some
Applicable Regions
EU: ESMO colorectal liver metastases guidelines
US: AHPBA/NCCN guidelines
Next steps
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Related Resources
Frequently Asked Questions
What is the Colorectal Liver Metastases Resectability Assessment?
The Colorectal Liver Metastases Resectability Assessment is a diagnostic clinical algorithm for Hepatobiliary Surgery. It provides a structured decision tree to guide clinical decision-making, based on AHPBA Consensus Guidelines on Colorectal Liver Metastases.
What guideline is the Colorectal Liver Metastases Resectability Assessment based on?
This algorithm is based on AHPBA Consensus Guidelines on Colorectal Liver Metastases (DOI: 10.1016/j.hpb.2022.03.002).
What are the limitations of the Colorectal Liver Metastases Resectability Assessment?
Known limitations include: Resectability criteria have expanded - MDT essential; Biologic factors (RAS, timing, response to chemo) matter; Two-stage hepatectomy and ALPPS expand resectability; Liver-directed therapy for unresectable can convert some. Individual patient factors may require deviation from these recommendations.
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