Advances in the management of colorectal liver metastases: 2026 Society for Surgery of the Alimentary Tract-Society of Surgical Oncology Joint Expert Symposium at Digestive Disease Week.

BACKGROUND

Colorectal liver metastases (CRLMs) remain a leading cause of death in patients with colorectal cancer and require increasingly sophisticated multidisciplinary management. Recent advances in systemic therapy, molecular profiling, hepatic surgery, liver-directed therapies, and liver transplantation have expanded treatment options while increasing the complexity of clinical decision-making. Herein we summarize the proceedings and expert recommendations from the 2026 Society for Surgery of the Alimentary Tract-Society of Surgical Oncology Joint Expert Symposium at Digestive Disease Week.

METHODS

An expert multidisciplinary panel comprising hepatopancreatobiliary surgical oncologists, hepatologists, transplant surgeons, and translational surgeon-scientists reviewed contemporary evidence and emerging data across the spectrum of CRLM management. Recommendations were synthesized through expert review and panel discussion.

RESULTS

The symposium highlighted evolving concepts in CRLM biology, including mechanisms of immune evasion within the hepatic tumor microenvironment and novel immunotherapeutic strategies. Current evidence supporting biologically tailored perioperative systemic therapy based on tumor sidedness and RAS/BRAF status was reviewed, along with optimized regimens and timing to reduce liver injury, and the emerging role of circulating tumor DNA in guiding adjuvant treatment. Contemporary surgical strategies emphasized parenchymal preservation, minimally invasive techniques, ablation, and maximizing salvageability after recurrence. Expanding indications for liver-directed therapies, arterial infusion, and liver transplantation in carefully selected patients with unresectable liver-limited disease were also discussed, incorporating data from recent randomized clinical trials.

CONCLUSION

Contemporary management of CRLM increasingly relies on individualized treatment strategies guided by tumor biology, preservation of hepatic reserve, and coordinated multidisciplinary decision-making. Integrating the latest evidence with expert discussion provides practical recommendations for optimizing long-term oncologic outcomes while identifying key areas for future clinical investigation.