Holistic Management of Synchronous Colorectal Liver Metastases in a High-Volume Center

Overview

This study analyzed the clinical management and outcomes of patients with synchronous colorectal liver metastases (CLM) treated at a high-volume cancer center. Using propensity score matching, it evaluated perioperative and long-term survival outcomes, emphasizing the benefits of centralized, multidisciplinary care.

Background

Colorectal cancer is a leading cause of cancer-related mortality worldwide, with synchronous colorectal liver metastases (CLM) increasingly diagnosed due to improved imaging. Synchronous CLM are associated with poorer survival compared to metachronous metastases. Current guidelines provide broad recommendations, but treatment strategies vary widely between institutions. High-volume centers tend to adopt more aggressive, coordinated multidisciplinary approaches, which may improve clinical outcomes.

Data Highlights

The study retrospectively analyzed consecutive patients undergoing first curative-intent liver resection for CLM from 2010 to 2021 at a high-volume center. Patients were categorized as exclusively internally managed or partially externally managed. Tumor Burden Score (TBS) was used to stratify tumor load. Preoperative chemotherapy was administered based on resectability status. Outcomes included morbidity, mortality, and overall survival, with complications graded by Clavien–Dindo classification.

Key Findings

• Centralized management at a high-volume institution enabled comprehensive multidisciplinary evaluation and treatment planning for synchronous CLM.
• There were no predefined criteria of unresectability; resectability was based on the ability to remove all disease with adequate liver remnant.
• Preoperative chemotherapy was used selectively for initially unresectable or marginally resectable CLM to improve surgical candidacy.
• Parenchyma-sparing liver resections were preferred to preserve liver function while maintaining oncologic radicality.
• Sequencing of primary tumor and liver metastasis resection was individualized, including simultaneous, classic, or liver-first approaches.
• Major morbidity was defined as Clavien–Dindo grade 3 or higher, with outcomes systematically recorded and analyzed.

Clinical Implications

Centralizing care for synchronous CLM in specialized high-volume centers facilitates a holistic, multidisciplinary approach that can optimize treatment sequencing and surgical strategies. Selective use of preoperative chemotherapy and parenchyma-sparing resections may improve resectability and preserve liver function. These practices support improved perioperative safety and potentially better long-term survival outcomes.

Conclusion

A holistic, multidisciplinary approach to synchronous colorectal liver metastases in a high-volume institution enables tailored treatment strategies that balance oncologic efficacy with preservation of liver function, potentially improving patient outcomes.

References

1. Global Cancer Statistics 2020 -- Colorectal Cancer Incidence and Mortality
2. Improved Imaging and Diagnosis of Synchronous CLM
3. Survival Differences Between Synchronous and Metachronous CLM
4. Consensus Guidelines on Surgical Management of Synchronous CLM
5. High-Volume Center Outcomes in CLM Management
6. Brisbane Classification of Liver Resection
7. Clavien–Dindo Classification of Surgical Complications
8. RECIST Criteria for Chemotherapy Response Evaluation
9. AJCC Cancer Staging Manual, 8th Edition
10. Declaration of Helsinki Ethical Principles