Version August 2025
| 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 |
