Management of colorectal cancer presenting with synchronous liver metastases

Up to a fifth of patients with colorectal cancer (CRC) present with synchronous hepatic metastases. In patients with CRC who present without intestinal obstruction or perforation and in whom comprehensive whole-body imaging confirms the absence of extrahepatic disease, evidence indicates a state of equipoise between several different management pathways, none of which has demonstrated superiority. Neoadjuvant systemic chemotherapy is advocated by current guidelines, but must be integrated with surgical management in order to remove the primary tumour and liver metastatic burden. Surgery for CRC with synchronous liver metastases can take a number of forms: the 'classic' approach, involving initial colorectal resection, interval chemotherapy and liver resection as the final step; simultaneous removal of the liver and bowel tumours with neoadjuvant or adjuvant chemotherapy; or a 'liver-first' approach (before or after systemic chemotherapy) with removal of the colorectal tumour as the final procedure. In patients with rectal primary tumours, the liver-first approach can potentially avoid rectal surgery in patients with a complete response to chemoradiotherapy. We overview the importance of precise nomenclature, the influence of clinical presentation on treatment options, and the need for accurate, up-to-date surgical terminology, staging tests and contemporary management options in CRC and synchronous hepatic metastatic disease, with an emphasis on multidisciplinary care

A conceptual framework to support decision-making in remanufacturing engineering processes

Remanufacturing is a promising industrial activity where products and materials are upgraded and considered for at least another life cycle. In addition to being an environmentally conscious action, remanufacturing has the potential to support circular economy within which significant profit opportunities exist. However, high levels of uncertainty can be experienced during, before and after remanufacturing. This makes its planning stochastic and hard to control. As each component or product is different, with for example high levels of geometrical variation; they may require a unique strategy and process planning. To aid this process, a conceptual decision making framework to support process planning of remanufacturing engineering processes (REP) is proposed. Quality Function Deployment (QFD) method is employed to support the proposed framework (hereafter referred to as REP-QFD). The application of the QFD based methods rely heavily on inputs from experts, in the form of their experience and knowledge. The paper considers how the proposed framework can be engineered with the aim to substantially reduce this reliance on experts and their expertise. The term “Engineering” here reflects the study’s focus on technical decisions at the reconditioning stage. To further support the framework a taxonomy of metal manufacturing/remanufacturing processes is also developed