Prognostic value of primary tumor site in surgery for colorectal liver metastases

Table 1 Evolving paradigms in the management of colorectal liver metastases

Principle	Traditional paradigm	New, biology-driven paradigm
Defining logic	Technical resectability of metastatic disease	Inherent biological aggressiveness of the primary tumor
Central prognostic factor	Metastatic burden (number and size of lesions)	Primary tumor location and its associated biologic phenotype
Role of primary tumor	Historical point of origin	Key regulator of metastatic behavior and host systemic response
Therapeutic goal	Standardised application guidelines	Risk-adapted site-specific intensification of multimodal therapy
Implied action	Uniform treatment protocols	Location-defined and molecular-informed treatment algorithms