Bowel first? Simultaneous resection? Liver first? Treatment options in patients with colorectal cancer and resectable synchronous liver metastases

In patients with colorectal liver metastases surgical resection is the only potentially curative therapy option, with reported 5- year- survival of up to 50%. Approximately 25% of all patients with colorectal cancer have synchronous liver metastases, which has been associated with extremely poor prognosis. Advances in hepatic surgery and improved response rates to modern chemotherapeutic and targeted agents have changed our approach to stage IV patients from palliative therapy towards an aggressive multidisciplinary strategy in curative intention. However, the optimal treatment sequence in these patients has not been clearly defi ned. Th is short review summarizes the advantages and disadvantages of three diff erent treatment approaches in patients with newly diagnosed colorectal cancer and resectable synchronous liver metastases.