FTP7.6 Management of Colorectal Cancer with Synchronous Liver Metastases: A systematic review of national and international clinical guidelines (CoSMIC-G)

Abstract

Abstract Introduction The contemporary management of patients with colorectal cancer and synchronous liver metastases is complex. Variation in interpretation of the limited body of evidence may introduce inequality in practice. This study appraises the recommendations made by national/international guidelines on the management of patients with synchronous liver metastases from colorectal cancer. Methods A systematic review of national and international professional body guidelines published between 2012-2022 was carried out using PubMed and Guidelines International Network and evaluated using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Guidance in was assessed for strength of recommendation and levels of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. The protocol was registered with PROSPERO (CRD42021243744). Results Searches returned 385 articles with 11 guidelines eligible for inclusion. One (9%) guideline defined ‘synchronous disease’ at outset, 2 (18%) recommended neo-adjuvant chemotherapy. Two guidelines provided “moderate” support for synchronous liver and bowel resection, 5 recommended against synchronous hepatic and colorectal resection and four made no comment. No guidelines described either hepatic or colorectal criteria for synchronous surgery. Discussion This study demonstrates important variations between clinical guidelines on management of synchronous liver metastases in colorectal cancer.