Treatment plan improvement by multidisciplinary case conferences for patients with colorectal cancer and synchronous liver metastases

Aggressive treatments of metastasized colorectal cancer have been shown to be promising strategies, offering survival probabilities between 40% and 50% in selected patients (1,2). These achievements, however, were only possible on the basis of improvements in surgical techniques and the introduction of potent chemotherapeutic and biological drugs, combined in meticulously defined regimens (2). Naturally, this requires multidisciplinary teamwork and individually tailored therapeutic approaches. Many factors influence this individualized decision process, such as the quality and interpretation of imaging, the availability of a portfolio of systemic and locally ablative treatment options besides surgery, the availability of innovative treatment options within clinical studies, and last but not least, the experience of all health care professionals involved in the various treatment steps, in particular the surgeons (2,3). Several surgical concepts have been proposed in the past to address metastatic disease at two sites in patients with synchronously metastasized colorectal cancer, such as the liver-first approach, simultaneous resection of the primary and synchronous liver metastases, two-step liver resection, or the conventional colon/rectum-first and liver-second approach—with or without systemic chemotherapy