1.0 INTRODUCTION

There has been increasing recognition of the potential benefits of liver resection for colorectal metastases in the UK although this treatment has been established more widely in other Western countries. There are no randomised studies assessing outcome following resection compared with no treatment or other therapeutic modalities in patients with known resectable liver metastases as it is generally considered unethical not to offer surgery for resectable disease. There has been increased interest in more aggressive chemotherapy regimens that have been reported to not only control metastatic disease but also to render some advanced liver metastases resectable.^1–4 Furthermore, other new modalities have become available that allow safe ablation of liver metastases without the need for surgical intervention. There is therefore a need to produce clear guidelines on the appropriate management of patients with colorectal cancer who have been shown to have hepatic metastases.

These guidelines are intended to address a number of issues:

1. the principles under which patients with hepatic metastases should be managed;

2. which patients who have undergone attempted curative resection of the primary colorectal tumour should be offered surveillance;

3. what investigations are required to determine appropriate management; and

4. which treatment modality is most appropriate in a given clinical context.

2.0 FORMULATION OF GUIDELINES

The process of formulating any clinical guidelines requires a guideline development group, a search strategy with review of the relevant literature, synthesis of evidence (and consensus methods for topics when evidence is lacking), followed by external review. A multidisciplinary meeting with representation from a number of interested bodies involving surgeons, gastroenterologists, oncologists, diagnostic and interventional radiologists, pathologists, general practitioners, clinical nurse specialists, nurse practitioners, and patients was held in the Pelican Centre in Basingstoke on 2–4 October 2003 (see appendix 1). The Appraisal of Guidelines Research and Evaluation (AGREE) instrument was used to provide a framework for assessing …