A 55-year-old man has an isolated synchronous liver metastasis (3 cm, segment VI) from a resected colon cancer (pT3N2 after curative right hemicolectomy). He has adequate hepatic reserve. Which is the most appropriate management strategy per current guidelines?
- A Systemic FOLFOX chemotherapy alone; liver resection reserved for progression
- B Radiofrequency ablation only, avoiding hepatic surgery
- C Synchronous or staged liver resection combined with perioperative FOLFOX (EORTC 40983 protocol) ✓
- D Liver transplantation for isolated hepatic colorectal metastasis
Explanation
The EORTC 40983 (EPOC) trial demonstrated that perioperative FOLFOX (6 cycles pre- + 6 cycles post-hepatic resection) plus surgery provides superior 3-year progression-free survival compared with surgery alone for resectable liver metastases. Current guidelines recommend hepatic resection (simultaneous or staged depending on colorectal primary status) as the only potentially curative option for isolated colorectal liver metastases. RFA may be used for unresectable lesions or combined with resection but is not the primary approach for resectable disease. Liver transplantation for colorectal metastases remains investigational (SECA trials).
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.