Study highlights The aim of this study was to evaluate the prognostic and predictive value of bone marrow circulating tumor cells and peripheral blood disseminated tumor cells in patients with metastatic colorectal cancer; the findings suggest that circulating tumor cells are predictors of inoperable resection and poor survival outcomes; furthermore, the study suggests that circulating tumor cell analysis should be used as a decision-making tool prior to liver resection in patients with metastatic colorectal cancer. In the February 6, 2014 online issue of Annals of Surgery, the results of a study by Dr. Gro Wiedswang et al. from the University of Oslo, Norway, were published in a study of patients with metastatic colorectal cancer referred for surgical treatment to evaluate patients’ bone marrow (BM) circulating tumor cells (CTCs) and peripheral blood disseminated tumor cells (DTCs). The study aimed to evaluate the prognostic and predictive value of bone marrow (BM) circulating tumor cells (CTC) and peripheral blood disseminated tumor cells (DTC). The results of this study showed that CTCs were a predictor of inoperable resection and poor survival outcome. In addition, the study suggests that CTC analysis should be used as a decision-making tool before liver resection for such patients. A total of 194 patients were covered in the study. In the study, patients were identified for treatment through a multidisciplinary treatment group. The researchers obtained BM puncture fluid and blood samples from patients by surgical means, or by local anesthesia for patients who could not be surgically resected. CTC and DTC were determined by means of the Cell Search System and immunocytology, respectively. A total of 153 patients underwent liver resection. 41 patients were unable to undergo surgical resection, 22 of which were determined preoperatively and 19 intraoperatively. The median follow-up period of the study was 22 months (range 1-61 months). Of the surgically resected patients, 103 were diagnosed with recurrence. CTCs were detected in 19.6% of patients, and the rate of positive CTCs was significantly higher in inoperable patients (46%) than in operable patients. 13.8% of patients had CTCs greater than or equal to 2, and 31% of inoperable patients and 9.1% of operable patients had 2 or more CTCs, respectively. The results of the analysis for all patients and operable The results of the analysis for all patients and surgically resectable patients showed that the time to recurrence/progression was shorter in patients with 2 or more CTCs. The presence of 2 or more CTCs was a strong predictor of progression and death in all subgroups, along with the presence of more than 3 liver metastases, R1 resection, and extrahepatic disease. 9.9% of patients were detected with DTC, but there was no association between DTC and clinical outcomes in surgically resectable patients. Patient disease-free/progression-free survival and overall survival outcomes Study background Colorectal cancer (CRC) is the third most common type of cancer in the world, with approximately 1.2 million new cases and 608,000 deaths each year. The cause of cancer-related death is metastasis. The liver is the most common site of metastasis, with liver metastases occurring in approximately 50% of patients with metastatic CRC and the liver being the only site of metastasis. Current advances in multidisciplinary treatment team (MT) discussions including oncologists, radiologists and surgeons, as well as novel therapeutic approaches, have significantly improved the outcome of these patients and have transformed the disease from a bleak prognosis to a potentially curable one. However, since the optimal treatment cannot be successfully identified, there is still a need to achieve screening of patients suitable for the appropriate treatment framework through credible predictor variables. Although several scoring systems have been proposed by the stakeholders. And there is also a need to examine the prognostic and predictive value of novel biomarkers. There are reports suggesting that bone marrow (BM) circulating tumor cells (CTCs) and peripheral blood disseminated tumor cells (DTCs) are independent prognostic factors for different epithelial tumors. robust data published by Cohen and colleagues suggest that CTCs have a detrimental effect on patients with metastatic CRC, and this result is supported by other investigators. However, data on CTC/DTC evaluations performed under clinical conditions are currently sporadic, and in addition, very few studies have used CTC and DTC status as screening criteria for surgical treatment of CRLM. The aim of this study was to evaluate the prognostic and predictive value of CTC and DTC test results in terms of operable resectability and patient survival in patients referred to a tertiary hepatobiliary and pancreatic surgery center for treatment by CRLM means.