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Colorectal Liver Metastases — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyColorectal Liver MetastasesRACP Adult Medicine

A 68-year-old man with colorectal cancer has liver-limited metastatic disease with 3 small resectable metastases confirmed by hepatobiliary MDT. His primary tumour has been resected. What is the recommended approach?

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Correct answer: DHepatic metastasectomy with perioperative chemotherapy

For colorectal cancer liver metastases (CRLM) deemed resectable by hepatobiliary MDT, hepatic metastasectomy offers the only chance of long-term survival/cure (5-year survival 25–50%). Perioperative chemotherapy (FOLFOX – EORTC 40983 trial) is generally administered before and after surgery. Resectability criteria include the ability to achieve clear margins while preserving adequate future liver remnant (>20–30%). RFA may complement surgery for small deep lesions.

Reference: Cancer Council Australia – 2022 – CRC Optimal Care Pathway