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Liver metastasis

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of liver metastasis are prepared by our editorial team based on guidelines from the Enhanced Recovery After Surgery Society (ERASS 2023), the European Association for the Study of the Liver (EASL 2023), the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS 2021), the European Federation of Societies for Ultrasound (EFSU 2020), and the ...
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Diagnostic investigations

Diagnostic imaging
As per JSHBPS 2021 guidelines:
Obtain preoperative MRI in addition to CT in patients with liver metastases planned to undergo operative resection.
B
Obtain MRI for the diagnosis of liver metastases disappearing after neoadjuvant therapy.
B
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  • Molecular testing

Medical management

Adjuvant chemotherapy
As per JSHBPS 2021 guidelines:
Offer systemic adjuvant therapy in patients with liver metastases from colorectal
B
and gastric cancers.
B
Offer adjuvant imatinib in patients with liver metastases from gastrointestinal stromal tumors.
B

Therapeutic procedures

Local ablation therapy: as per JSHBPS 2021 guidelines, avoid preferring local ablation therapy over hepatic resection in patients with colorectal liver metastases.
D

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  • Embolization

Perioperative care

Preoperative care, counseling
As per ERASS 2023 guidelines:
Provide preoperative information and counseling regarding the upcoming liver surgery. Consider using brochures and multimedia support to improve verbal counseling.
B
Advise preoperative smoking cessation at least 4 weeks before hepatectomy. Advise alcohol cessation in heavy drinkers (> 24 g/day for females or > 36 g/day for males) 4-8 weeks before surgery.
A

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  • Preoperative care (nutrition)

  • Preoperative care (rehabilitation)

  • Preoperative care (biliary drainage)

  • Preoperative care (antibiotic prophylaxis)

  • Preoperative care (corticosteroids)

  • Preoperative care (preanesthetic medication)

  • Intraoperative care (anesthesia and analgesia)

  • Intraoperative care (temperature management)

  • Intraoperative care (fluid management)

  • Postoperative care (thromboprophylaxis)

  • Postoperative care (early mobilization)

  • Postoperative care (nutrition)

  • Postoperative care (antiemetics)

  • Postoperative care (laxatives)

Surgical interventions

Hepatectomy, indications: as per JSHBPS 2021 guidelines, perform parenchymal-sparing over major hepatectomy in patients with liver metastases from CRC.
B
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  • Conversion surgery

  • Hepatectomy (technical considerations)

Specific circumstances

Pregnant patients: as per EASL 2023 guidelines, obtain ultrasound surveillance in pregnant patients with a history of extrahepatic cancers known to metastasize to the liver. Obtain careful multidisciplinary follow-up, including adherence to recommended oncological management for non-pregnant patients, if metastases are identified.
B