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Title:           Multisocietal 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
Subject:         DOI: 10.1093/bjs/znad124; British Journal of Surgery, 110, 9, 2023-07-13.; 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 multiorganizational, 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 per cent 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 12 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, the term ‘late metachronous metastases’ applies to those detected after 12 months. ‘Disappearing metastases’ applies to lesions that are no longer detectable on MRI 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. Conclusion: The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.
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      Title: Multisocietal 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
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        Title: Introduction
        Destination: secznad124-s0
       Item: 
        Title: Methods
        Destination: secznad124-s1
        Children: 
         Item: 
          Title: Overview and scope
          Destination: secznad124-s1.1
         Item: 
          Title: Participants
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         Item: 
          Title: Design and content of statements for consensus
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         Item: 
          Title: Consensus process
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         Item: 
          Title: Assembly of consensus report
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         Item: 
          Title: Role of sponsors in consensus process
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         Item: 
          Title: Ethics
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         Item: 
          Title: Planned review and renewal
          Destination: secznad124-s1.8
       Item: 
        Title: Results
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        Children: 
         Item: 
          Title: Terminology for description of synchronous and metachronous liver metastases
          Destination: secznad124-s2.1
         Item: 
          Title: Scope and constitution of a multidisciplinary team (tumour board) for management of patients with synchronous colorectal cancer and liver metastases
          Destination: secznad124-s2.2
         Item: 
          Title: Diagnostic tests
          Destination: secznad124-s2.3
         Item: 
          Title: Clinical management of the patient with synchronous colorectal cancer and liver metastases and an emergency presentation
          Destination: secznad124-s2.4
         Item: 
          Title: Further clinical assessment of the patient with synchronous colorectal cancer and liver metastases and an elective presentation
          Destination: secznad124-s2.5
         Item: 
          Title: Considerations for ‘upfront’ synchronous resection of liver tumour(s) and bowel primary tumour in patients with resectable synchronous colorectal cancer and liver metastases
          Destination: secznad124-s2.6
         Item: 
          Title: Considerations for ‘upfront’ systemic chemotherapy in patients with synchronous colorectal cancer and liver metastases
          Destination: secznad124-s2.7
         Item: 
          Title: Considerations for a ‘bowel-first’ approach in patients with synchronous colorectal cancer and liver metastases
          Destination: secznad124-s2.8
         Item: 
          Title: Considerations for a ‘liver-first’ approach after systemic chemotherapy in patients with synchronous colorectal cancer and liver metastases
          Destination: secznad124-s2.9
         Item: 
          Title: Terminology and management of ‘disappearing’ liver metastases
          Destination: secznad124-s2.10
         Item: 
          Title: Management of synchronous pulmonary metastases in patients with synchronous colorectal cancer and liver metastases
          Destination: secznad124-s2.11
         Item: 
          Title: Role of minimally invasive surgery in management of colorectal cancer with synchronous liver metastases
          Destination: secznad124-s2.12
       Item: 
        Title: Discussion
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       Item: 
        Title: Collaborators
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       Item: 
        Title: Collaborator institutional affiliations
        Destination: secznad124-s5
       Item: 
        Title: Author contributions
        Destination: secznad124-s7
       Item: 
        Title: Funding
        Destination: secznad124-s6
       Item: 
        Title: Acknowledgements
        Destination: acknow
       Item: 
        Title: Disclosure
        Destination: secznad124-s8
       Item: 
        Title: Supplementary material
        Destination: secznad124-s10
       Item: 
        Title: Data availability
        Destination: secznad124-s9
       Item: 
        Title: References
        Destination: reflist
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    Title: Multisocietal 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
    Author: Ajith K. Siriwardena
    Subject: DOI: 10.1093/bjs/znad124; British Journal of Surgery, 110, 9, 2023-07-13.; 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 multiorganizational, 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 per cent 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 12 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, the term ‘late metachronous metastases’ applies to those detected after 12 months. ‘Disappearing metastases’ applies to lesions that are no longer detectable on MRI 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. Conclusion: The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.
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  Checksum: 3574b914
   Type: CRC32
  Checksum: d8b6ed1c11188cfd9d88ae027a54d826
   Type: MD5
  Checksum: 2fcafa88e96bdb94d4d915a1acfec4de94faaec3
   Type: SHA-1
  Checksum: 0c79e344f5d76d9eee3008442d7a90c3e1bec14b40dd79a84f6030a73dd49902
   Type: SHA-256