Colorectal Liver Metastases Diagnosed
Imaging-confirmed liver-limited or oligometastatic disease
All Pathways
Hepatobiliary SurgeryDiagnostic
Colorectal Liver Metastases Resectability Assessment
Colorectal Liver Metastases Resectability Assessment: Colorectal Liver Metastases Diagnosed → Complete Staging → Technical Resectability → Technically R...
Pathway Overview
14 steps
Algorithm Steps
14 total
01Start 02Action Complete Staging
CT C/A/P, PET-CT, liver MRI
- Confirm liver-limited (or limited extrahepatic)
- Assess primary tumor status
- RAS/BRAF mutation status
03Decision Technical Resectability
- R0 resection achievable?
- FLR >20-30% (>40% if chemo)
- Adequate vascular inflow/outflow
- ≥2 contiguous segments preserved
04Action Technically Resectable
Upfront surgery or neoadjuvant
05Decision Oncologic Risk Assessment
- CRS (Fong) or GAME score
- Node+, CEA >200, >1 tumor, size >5cm
- DFI <12 months, extrahepatic disease
06Action Low Risk
Consider upfront resection
- Synchronous: staged or simultaneous
- Metachronous: resection
07Action Hepatic Resection
Parenchymal-sparing preferred
- Anatomic or wedge resection
- Laparoscopic if feasible
- R0 resection goal
08End Adjuvant Therapy & Surveillance
Complete periop chemo, imaging surveillance
09Action High Risk
Neoadjuvant chemotherapy
- FOLFOX/FOLFIRI ± targeted
- Assess response before surgery
- Test tumor biology
- Path rejoins step 07Shared downstream outcome
10Action Borderline Resectable
May become resectable
11Action Conversion Strategy
Intensive chemotherapy
- FOLFOXIRI + bevacizumab
- Reassess q8 weeks
- Liver-directed therapy (Y90, SBRT)
- Path rejoins step 07Shared downstream outcome
12Action Palliation/Systemic
If remains unresectable
- Path rejoins step 08Shared downstream outcome
13Action FLR Augmentation
If insufficient FLR
- PVE (portal vein embolization)
- Two-stage hepatectomy
- ALPPS if needed
- Path rejoins step 07Shared downstream outcome
14Action Unresectable
Conversion therapy needed
- Path rejoins step 11Shared downstream outcome
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
USAUUKEU
EU: ESMO colorectal liver metastases guidelines
US: AHPBA/NCCN guidelines
Version 1Next review: 2028-01-01
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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