Optimal treatment sequence in colorectal cancer patients with synchronous liver metastases

In patients with metastatic colorectal cancer, surgical metastasectomy is currently an obligatory component of curative treatment regimens. Optimized multimodal treatment concepts and improved surgical methods have resulted in a clear improvement of the prognosis. In particular, the number or size of liver metastases is no longer decisive for deciding between a curative and a palliative concept. In the case of synchronous hepatic metastases, the resection of the primary tumor and liver metastases can be carried out either sequentially in two surgical procedures (primary first or liver first) or in one procedure (combined approach). According to the current evidence, the oncological long-term outcome does not significantly differ between the three approaches. Therefore, the treatment strategy should be selected individually, considering disease-specific factors (e.g. primary tumor location, number and location of liver metastases) and individual factors (e.g. age and comorbidities) as well as institutional expertise and resources.