Moderator: Dr Alex Muturi

Speakers & Topics:

• Prof Olusegun Alatise: Surgical & Gastroenterology Perspectives in mCRC Management
• Dr Andrew Odhiambo: First‑Line Therapy in mCRC – With or Without?

Global and African Burden of CRC

– CRC is the third most diagnosed cancer globally with an increasing burden in LMICs.
– African patients show distinct molecular and clinical features, including poor survival outcomes.

Principles of Metastatic CRC Management

– Multidisciplinary approach is essential; cure remains possible in select patients.
– Surgery for metastasis should be guided by tumor biology, technical feasibility, and patient fitness.
– Synchronous vs metachronous disease influences treatment sequencing.

Imaging and Surgical Considerations

– Triphasic CT, MRI with contrast, and PET scans are standard.
– Resectability is based on liver function and margin clearance, not number/size of lesions.

Surgical and Interventional Therapies

– Options: surgical resection, ablation, HAIP chemotherapy, two-stage hepatectomy, ALPPS, SIRT.
– Preoperative chemotherapy helps with tumor downsizing and biology assessment but may impair liver function.

Genetic and Prognostic Scoring

– CRS, GAME, MRS, and MSI/BRAF/TP53 profiles aid in stratifying patients.
– Even high-risk patients can achieve long-term survival with careful selection.

Newer Modalities

– Thermal ablation is effective for small (<3cm) liver lesions.
– Liver transplant is under investigation for select liver-only, unresectable CRC.

Peritoneal Carcinomatosis

– Cytoreductive surgery + HIPEC has survival benefits in low PCI scores.
– PRODIGE 7, COLOPEC, and PROPHYLOCHIP trials show limited benefit of prophylactic HIPEC

Conclusion

– Metastatic CRC is treatable; coordinated, case-specific care improves survival.
– Early detection and healthcare system strengthening in Africa are vital.