Management of the Primary Colorectal Cancer and Synchronous Liver Metastases

Abstract

In the last two decades, advances in liver surgery and systemic therapy have increased the scope and complexity of curative treatment of metastatic colorectal cancer. Synchronous liver metastasis represents a particularly challenging scenario where resection of the primary cancer and liver disease should be contemplated while still offering systemic therapy. Different treatment sequences have been proposed aiming to optimize long-term survival and decrease cumulative treatment-related morbidity. Safety and feasibility of colorectal-first, combined, and liver-first approaches have been demonstrated in selected subgroups of patients, but comparative analyses are undermined by the retrospective design and heterogeneity of available studies. The concept of a unifying ideal therapeutic approach does not seem realistic, and understanding the distinct principles of different strategies is paramount when planning surgical management of synchronous colorectal liver metastases. The role of systemic therapy before liver resection still requires better characterization.