Tom Reeve Academic Surgical Clinic  ·  St Leonards

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Thomas J. HughSpecialist Hepato-Biliary & General Surgeon
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Research · Liver metastases

Colorectal cancer with liver metastases

Colorectal cancer with liver metastases is treatable for many Australians when surgery is combined with modern chemotherapy. Thomas J. Hugh's early work with Professor Poston shaped liver metastases treatment pathways still used in Sydney multidisciplinary clinics.

This page explains liver metastases in plain language, alongside peer-reviewed work by Thomas J. Hugh and colleagues.

Plain-language patient guide
/ 01Overview

What are colorectal liver metastases?

Colorectal liver metastases are secondary tumours in the liver spread from bowel cancer. They are not the same as primary liver cancer. Many patients present years after the original bowel resection; others are diagnosed with bowel and liver disease together. Staging scans define whether cure-oriented surgery is possible.

Hugh and Poston's 1997 ANZ Journal of Surgery review on aetiology and management of hepatic metastases remains a foundation for understanding CRLM biology.

Tom Hugh continues to operate within teams that sequence chemotherapy and colorectal liver metastases surgery.

/ 02Evidence

What liver metastases treatment options exist?

Liver metastases treatment includes systemic chemotherapy, targeted therapy, ablation, embolization, and liver resection. The aim may be cure when all visible disease can be removed or destroyed. Conversion therapy shrinks tumours so surgery becomes possible. Every plan is individualised at tumour board.

Hugh, Kinsella, and Poston (1997) Surgical Oncology two-part series outlined investigation and surgical versus non-surgical options for colorectal liver metastases.

Lane and Hugh (2018) explored locoregional drug delivery research, reflecting ongoing innovation beyond standard chemotherapy.

ModalityRole in CRLM
Chemotherapy / biologicsShrink tumours, control micrometastatic disease
Liver resectionBest chance of long-term survival when complete
Ablation / embolizationSmall lesions or adjunct when resection incomplete
MDT reviewIntegrates bowel, liver, and oncology timing
/ 03Evidence

Who is suitable for colorectal liver metastases surgery?

Suitability depends on tumour number and location, future liver volume, extrahepatic disease, and fitness. Historical limits on tumour count have relaxed with better chemotherapy and surgery. Hadden, de Reuver, and Hugh (2016) meta-analysed resection when limited extra-hepatic disease is present.

Brown, Samra, and Hugh (2019) used propensity scoring to compare anatomical versus non-anatomical liver resection for metastases, informing technical debates.

Thomas J. Hugh discusses realistic goals of care at first St Leonards appointment.

/ 04Evidence

Do complications after liver resection for metastases affect survival?

Serious complications matter for recovery but do not always shorten cancer-specific survival when metastases are successfully cleared. Pang, Samra, and Hugh (2015) showed complications following liver resection for colorectal metastases did not impact long-term outcome in their HPB series.

That finding reassures patients that a difficult hospital course can still align with good oncologic results when disease is controlled.

/ 05Evidence

How does molecular testing change CRLM care?

KRAS, MMR, and other markers guide chemotherapy and prognosis. Lumba et al. (2013) stratified outcomes after metastasectomy by KRAS status in an Australian cohort. Alvarado-Bachmann and Hugh (2014) examined mismatch repair defects in colorectal liver metastases.

Tom Hugh integrates these biomarkers into discussions with medical oncologists before resection.

/ 06Publications

Peer-reviewed publications by Thomas J. Hugh

The papers below are a selection of 66 papers from over 300 publications by Tom Hugh and collaborators, focused here on liver metastases. Where a DOI or publisher link is available, it opens in a new tab so you can read the original research.
/ 07About the author

Who writes and operates from this evidence base?

Thomas J. Hugh is a specialist Upper GI and hepato-biliary surgeon and Chair of Surgery at the University of Sydney Northern Clinical School. He operates at Royal North Shore Hospital and North Shore Private, with consultations at the Tom Reeve Academic Surgical Clinic in St Leonards.

Outcomes across his practice are tracked through the DASO audit unit. That combination of published research and prospective audit is intended to keep advice grounded in measured results, not marketing claims.

Read more about Tom Hugh
/ 08Common questions

Complete resection (sometimes plus ablation) offers the best chance of long-term survival. It is not guaranteed, but many patients live years disease-free.

Sometimes both are staged in one plan; other times chemotherapy comes first or bowel and liver operations are separated. MDT decides sequence.

Repeat resection or ablation can be possible for limited recurrence. Hugh's research portfolio includes repeat liver surgery outcomes.

/ 09Related reading