Introduction : The management of stage IV colorectal cancer would be optimized by bringing together all relevant specialties involved in colorectal liver metastases (CRLM) management in a centralized high volume liver cancer surgery centre. The major objective is to increase resectability so as to achieve long-term patient survival (> 5years). 80% of CRLM are initially non-resectable due to tumour size, location and functional liver reserve. New chemotherapy regimens including biologicals are bringing more patients to resection. Including resectable extrahepatic disease, resectability is the complete removal of liver metastases while leaving at least 30% of remnant liver.

Methods : A BASO Ronald Raven travelling fellow ‘2 week’ observational study on the role of the advanced MDT in the management of Stage IV Colorectal Cancer (CRC) at the Aintree hepatobiliary centre, Liverpool (UK).

Results : There are 4 clinical scenarios of stage IV colorectal cancer; (1) asymptomatic CRC and resectable colorectal liver metastases (CRLM), (2) asymptomatic CRC and unresectable synchronous CRLM, (3) symptomatic CRC and resectable synchronous CRLM, (4) symptomatic CRC and unresectable synchronous CRLM. 10 -20% of patients with liver limited disease are resectable with curative intent, 10% are amenable to resection with ablation or two stage hepatectomy, with concomitant resectable extrahepatic disease (i.e. borderline resectable) and thus requiring induction chemotherapy and 30-40% of patients with initially limited unresectable disease are made resectable by chemo/biological therapy.

Conclusions : The major end-point of the advanced MDT approach to stage IV colorectal cancer management is resectability due to the impact on patient survival ( 40% > 5years, 20-30% in 10yrs).