**5.4 Synchronicity: Colorectal tumour and liver metastases**

On the international registry of liver metastasis from CRC, LiverMet Survey, a 51.7% of synchronicity has been recorded in January 2011 (table 1). This frequent sort of presentation, together with the expansion of the criteria of resectability and the laparoscopic approach for the colorectal and liver surgery, have created a new insight within the multidisciplinary teams.


Table 1. LiverMet Survey, January 2011. Survival rates in 11836 patients after hepatectomy (with permission).

As mentioned, colon resection can be done on the first stage, or a liver approach can be done first after a downstaging of the liver tumour/tumours. What should be done first depends on

Fig. 3. Multiple and bilobar metastases, right hydronephrosis and rectum cancer involving the right ovarium in a 37 year old woman. After chemotherapy treatment, first stage surgery consisted of tumour clearance of the left liver, anterior colorectal resection, right oophorectomy and right PVE (lower pictures). Five weeks later an extended right hepatectomy was performed.

On the international registry of liver metastasis from CRC, LiverMet Survey, a 51.7% of synchronicity has been recorded in January 2011 (table 1). This frequent sort of presentation, together with the expansion of the criteria of resectability and the laparoscopic approach for the colorectal and liver surgery, have created a new insight within the multidisciplinary teams.

Sincronic 6112 90% 58% 39% 22% Metacronic 5724 90% 60% 43% 26% Table 1. LiverMet Survey, January 2011. Survival rates in 11836 patients after hepatectomy

As mentioned, colon resection can be done on the first stage, or a liver approach can be done first after a downstaging of the liver tumour/tumours. What should be done first depends on

**patients 1 year 3 year 5 year 10 year** 

**5.4 Synchronicity: Colorectal tumour and liver metastases** 

**Sinc/Metac Number of** 

(with permission).

the primary tumour (mainly in cases of rectal cancer that require an ultralow resection or are T3 or T4) and on the volume of liver parenchyma that needs to be removed. If the patient has been downstaged to resectability, the liver should be approached first (if possible) and the colorectal tumour should be operated 4 to 6 weeks later (Figure 4).

Fig. 4. Large liver metastasis involving the three hepatic veins (upper pictures) in a 61 year old patient with rectal cancer. After 3 months of chemotherapy (lower pictures) the patient underwent left hepatectomy, segment (Sg) 1 and Sg 8 segmentectomies and right hepatic vein reconstruction. Six weeks later the rectal cancer was resected.
