A 62-year-old man undergoes anterior resection for rectal cancer. Six months later, follow-up CT shows 3 synchronous liver metastases: two in segments VI/VII (largest 2.8 cm) and one in segment IV (1.5 cm). CEA is 18 ng/mL. The oncology team discusses colorectal liver metastases (CRLM) resectability. Which factor would definitively render this patient UNRESECTABLE by international consensus criteria?
- A Involvement of all 3 hepatic veins with future liver remnant of 18% of total liver volume ✓
- B Three metastases in bilobar distribution
- C CEA level above 10 ng/mL
- D Disease-free interval of only 6 months from primary resection
Explanation
Resectability of CRLM is determined by ability to achieve R0 resection with adequate future liver remnant (FLR), not tumor number or bilobar distribution. An FLR of <20% (or <30% in patients who received extensive chemotherapy, or <40% in cirrhosis) is a contraindication to resection due to risk of post-hepatectomy liver failure. Involvement of all 3 hepatic veins with FLR of only 18% represents technical unresectability. Number of metastases, CEA level, and disease-free interval are prognostic factors affecting the Clinical Risk Score (Fong score) but not absolute contraindications. Portal vein embolization can be used to increase FLR before resection.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.