Liver-limited oligometastatic colorectal cancer (CRLM, colorectal liver metastases) — a d...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-CRC-OLIGOMET-LIVER-DEFINITION`
Type	Red flag
Status	reviewed 2026-05-08 \| pending_clinical_signoff
Diseases	`DIS-CRC`
Sources	`SRC-ESMO-COLON-2024` `SRC-ESMO-CRC-2024` `SRC-NCCN-COLON-2025`

Red Flag Origin

Definition	Liver-limited oligometastatic colorectal cancer (CRLM, colorectal liver metastases) — a distinct subset of stage IV CRC where intensified treatment with hepatic resection (or ablation) added to systemic chemo is potentially curative. Definition (per NCCN Colon v3.2025 + ESMO CRC 2024 + EORTC 40983 / Nordlinger 2008 trial framework): ≤5 liver metastatic lesions, all R0-resectable on multidisciplinary review, no extrahepatic disease, ECOG 0-1 fitness, controllable primary tumour. Triggers MDT (medical onc + hepatobiliary surgery + radiation onc + radiology) consideration of perioperative FOLFOX (or FOLFOXIRI in selected patients) + hepatic metastasectomy. Distinct from gastroesophageal OMEC-1 oligomet (RF-OLIGOMET-DEFINITION) — CRC oligomet uses ≤5 liver lesions (not ≤3 distant), restricts to liver only (extrahepatic excluded), and HER2-positive does NOT disqualify (anti-HER2 second-line...
Clinical direction	intensify
Category	high-risk-biology

Trigger Logic

{
  "all_of": [
    {
      "comparator": "<=",
      "finding": "liver_metastasis_count",
      "threshold": 5
    },
    {
      "finding": "all_liver_lesions_r0_resectable",
      "value": true
    },
    {
      "comparator": "<=",
      "finding": "ecog_performance_status",
      "threshold": 1
    },
    {
      "finding": "primary_tumor_controllable",
      "value": true
    }
  ],
  "none_of": [
    {
      "finding": "extrahepatic_metastasis",
      "value": true
    },
    {
      "finding": "peritoneal_carcinomatosis",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

Liver-limited CRC oligometastatic criteria (basis: NCCN Colon v3.2025 "Resectable Synchronous Liver-Only Metastases" pathway + ESMO CRC 2024 + EORTC 40983 / Nordlinger Lancet 2008 trial framework): 1. ≤5 liver metastatic lesions (numerical threshold; some series extend to ≤7 with future-liver-remnant feasibility, but ≤5 is the conservative MDT cutoff used by NCCN/ESMO consensus). 2. All liver lesions R0-resectable on hepatobiliary surgical review, with adequate future liver remnant (≥30% in normal liver, ≥40% post-chemo, ≥50% in cirrhosis). 3. NO extrahepatic disease (lung mets, peritoneal carcinomatosis, extra-hepatic LN, distant LN beyond pericolic / mesorectal — all exclusions; if extrahepatic disease is also limited and resectable, treatment is individualised outside this RF and belongs to a future "CRC limited-met multi-organ" indication not in scope here). 4. ECOG 0-1 (fit for hepatectomy + perioperative chemo). 5. Controllable primary tumour (resected or resectable; no perforation / obstruction at the moment of intensification decision — RF-CRC-EMERGENCY-OBSTRUCTION-PERFORATION takes precedence and routes to emergency management first). CRC-specific differences from gastroe...

Liver-limited oligometastatic colorectal cancer (CRLM, colorectal liver metastases) — a d...

Red Flag Origin

Trigger Logic

Notes

Used By

Algorithms

Indications