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    Patent Pending

    Fong Clinical Risk Score for Colorectal Cancer Recurrence

    Predicts recurrence for colorectal cancer patients with liver metastasis after hepatic resection.
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    About the Creator
    Dr. Yuman Fong
    Content Contributors
    • Stephanie Kim, MD
    • Alexis Grucela, MD

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Patients with Fong Score 0-2 are considered “low risk” and may proceed with surgical intervention.
    • Patients with Fong Score 3-5 are considered “high risk” and may benefit from close surveillance if surgery is deemed unacceptably high risk, additional preoperative workup/treatment before surgery, or additional postoperative treatment.

    Management

    From Khatri 2005:

    Conventional indications

    Modern aggressive approach

    <4 metastases, unilobar disease

    No limits. Multiple/bilobar metastases acceptable, using neoadjuvant chemotherapy, staged resection, and resection/local ablative therapy.

    Size <5 cm

    No limits.

    No extrahepatic disease

    Pulmonary metastases can be resected.

    Resection margin >1 cm

    Resection margin <1 cm managed with ablative treatment of narrow margin (cryosurgery or radiofrequency ablation).

    Adequate remnant liver parenchyma

    Preoperative portal vein embolization to increase liver remnant volume.

    Resection of all macroscopic disease

    NED can be achieved with combination of resection and local ablative therapy.

    No metachronous liver metastases

    Synchronous and metachronous metastases acceptable.

    Absence of vena cava and hepatic vein confluence invasion

    No limits. Caval/hepatic vein resection with reconstruction can be performed.

    Absence of hepatic pedicle lymph node metastases

    In absence of celiac axis metastases, hepatic pedicle lymph node metastases may be resected for improved 3-year survival.

    Critical Actions

    • About 1/3 of 5-year survivors ultimately die from their disease, and it is not yet certain whether the Fong Score accurately predicts survival beyond five years. Therefore, continued surveillance is currently recommended for patients after five years even if they are considered “low risk.”
    • With continued advances in surgery, re-resection of hepatic metastases is proven to be still low risk while conferring a survival benefit, and therefore should be considered.
    Content Contributors
    • Stephanie Kim, MD
    • Alexis Grucela, MD