Synchronous Presentation of Primary and Colorectal Liver Metastasis: Classic, Reverse, and Combined

The liver is the most common site of metastatic disease, with an estimated 15–25% of colorectal cancer (CRC) patients at the time of diagnosis presenting with synchronous colorectal liver metastases (SCRLM). Patients with synchronous liver metastases presenting at clinical evaluation for resection have increased in number, and dealing with these patients has become extremely frequent in the daily practice of a hepatobiliary center. The best surgical strategy for these patients is a matter of endless debate. The primary-first, the liver-first, and the simultaneous combined approaches should not be mutually exclusive but rather proposed to different types of patients. Surgical strategy should be based on liver and colorectal tumour burden, and on evaluation of surgical risk of planned surgery. The real possibility to obtain prolonged survivals and also cure of these patients is based on the best combination of modern systemic chemotherapy with safe surgery. The early discussion involving dedicated medical oncologist, liver surgeon, colorectal surgeon, radiotherapist in the management of a patient with colorectal cancer and synchronous liver metastases is crucial to best determine the timing and sequence of chemotherapy and surgery, the radiotherapy when indicated, and hence to improve patient outcomes and survival.