Management of Colorectal Cancer with Synchronous Liver Metastases: A Systematic Review of National and International Clinical Guidelines (CoSMIC-G)

Abstract

Introduction: The World Health Organization’s (WHO) Health Research Advisory Committee recommends that evidence informs best practice. This study systematically reviews national guidelines for the management of patients with colorectal cancer with a specific focus on the advice for patients with synchronous liver-limited or liver-dominant metastases. Methods: This is a systematic review of clinical guidelines for the management of colorectal cancer with a specific focus on the advice for patients with synchronous liver metastases. The National Library of Medicine PubMed database was queried for metastatic colorectal cancer guidelines using the keywords “colorectal cancer”, “liver” and “guidelines”. Studies are included if they are national guidelines on the management of patients with colorectal cancer. The study period for inclusion is the ten year period from January 2011 to January 2021. The protocol was registered with PROSPERO (registration number CRD42021243744). Results: Searches returned 302 unique articles of which nineteen were colorectal cancer and/or metastatic colorectal cancer guidelines. For the purposes of this report, the 7 guidelines of the NCCN (USA), NICE (UK), France, Spain, Japan, China and Australia are included. Five (72%) recommend against routine use of FDG-PET for staging. All guidelines support neoadjuvant chemotherapy as the first treatment. Two (29%) support liver surgery as first step. Six support and 1 discourage synchronous surgery. Hepatic criteria for synchronous are defined in 2 (29%) and primary tumour criteria in 2 (29%). Conclusion: There is substantial variation between international guidelines on recommendations for the management of patients with colorectal cancer and synchronous liver metastases.