SMDT SMDT SMDT Synchronous Metastasis on Staging/Surveillance

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Presentation transcript:

SMDT SMDT SMDT Synchronous Metastasis on Staging/Surveillance CT chest abdomen & Pelvis + CEA + MRI Liver /PET-CT Synchronous multiple peritoneal mets/extrahepatic nodal disease/unresectable lung mets (to be decided by lung MDT) Video-Link PHNT Symptomatic primary with metastasis SMDT Stenting/resection Palliative chemotherapy Resectable liver only and/or lung mets/High volume liver mets/Liver and lung mets /High risk primary Potentially resectable liver and or lung mets Neo-adjuvant chemotherapy Re-stage with CT chest abdomen & Pelvis (Consider MRI) SMDT Progression of metastasis and or unresectable Resectable Second line Chemo Asymptomatic primary and liver mets Symptomatic primary and liver mets Liver and lung mets with or without symptomatic primary Re-stage (CT chest abdomen & Pelvis (Consider MRI) See in clinic and consider for resection /CPET SMDT LIVER resection ★★Synchronous resection Bowel first/ ★★Synchronous resection LIVER followed by lung and bowel resection/ ★★Synchronous resection Good response and resectable No response - palliative treatment Consider SIRT/TACE Follow up in 4-6 weeks Histology discussion in SMDT PHNT patients FUP by HPB/Oncology Non-PHNT patients FUP by local oncology team ★★Only wedge or left lateral and major colonic resection/major Liver resection with Hartman's ✪High-risk factors for recurrence and metastases: poorly differentiated histology, lymphatic/vascular invasion, bowel obstruction, <12 lymph nodes examined, perineural invasion, localized perforation, or close, indeterminate, or positive margins.

SMDT SMDT SMDT Metachronous Metastasis on Staging/Surveillance CT chest abdomen & Pelvis + CEA + MRI liver Multiple peritoneal mets/extrahepatic nodal disease/lung mets- unresectable (to be decided by lung MDT) Video-Link PHNT SMDT Palliative chemotherapy Resectable liver only mets (long interval from primary surgery and adjuvant chemotherapy) ✪ High risk primary, Resectable high volume liver only mets – consider PET-CT Resectable liver and lung mets/ consider PET-CT Potentially resectable liver and or lung mets/ Consider PET-CT Neo-adjuvant chemotherapy Restage- CT chest, abdomen & pelvis See in clinic and consider for resection /CPET SMDT Resectable Progression of metastasis LIVER resection Second line Chemo See in clinic and consider for resection /CPET Restage- CT chest, abdomen & pelvis Liver followed by lung resection SMDT See in clinic and consider for resection /CPET Follow up in 4-6 weeks Histology discussion in SMDT Good response and resectable No response - palliative treatment Consider SIRT/TACE Non-PHNT patients FUP by local oncology team PHNT patients FUP by HPB/Oncology ✪High-risk factors for recurrence: poorly differentiated histology, lymphatic/vascular invasion, bowel obstruction, <12 lymph nodes examined, perineural invasion, localized perforation, or close, indeterminate, or positive margins.

Synchronous rectal cancer with metastasis on Staging CT chest abdomen & Pelvis+ CEA metastases + MRI Liver and pelvis + PET-CT Synchronous multiple extrahepatic nodal abdominal /peritoneal metastasis/medically inoperable /unresectable lung mets (to be decided by lung MDT) Video-Link PHNT SMDT Palliative chemotherapy Any T, Any N, and Resectable synchronous metastases Any T, Any N, and potentially Resectable synchronous metastases- Neo-adjuvant chemotherapy +/- Pelvic RT (Oncologists decision) Restage -CTTAP And MRI pelvis SMDT Resectable Progression of metastasis and or unresectable Second line Chemo Asymptomatic primary and liver mets Symptomatic primary and liver mets Liver and lung mets Re-stage CTTAP See in clinic and consider for resection /CPET SMDT LIVER resection ★★Synchronous resection Anterior/APR first/ ★★Synchronous resection LIVER followed by lung and bowel resection/ ★★Synchronous resection Good response and resectable No response - palliative treatment Follow up in 4-6 weeks Histology discussion in SMDT PHNT patients FUP by HPB/Oncology Non-PHNT patients FUP by local oncology team ★★Only wedge or left lateral and major colonic /rectal resection/major Liver resection with Hartman's