Background: Surgical management of patients with colorectal cancer (CRC) and synchronous liver metastases (CRLM) has evolved significantly during the past decades. An increasing number of studies have demonstrated encouraging Results in selected patients undergoing synchronous resections (SR) of the primary CRC and CRLM. The aim of our study was to evaluate the safety and efficacy of our Colon-Liver-Colon (COLICO) operative sequence approach in patients undergoing synchronous resections. Materials and Methods: Outcomes of patients who underwent SR of primary CRC and CRLM at our institution from by one certified HPB surgeon during a 4-year period were retrospectively evaluated. During the COLICO operative sequence, the CRC resection was initially performed without creation of anastomosis, followed by LM resection and finally creation of the bowel anastomosis in the absence of factors, which could postoperatively compromise its integrity. Results: A total of 15 patients (6 men) underwent SR of CRC and CRLM. Right colectomy, sigmoidectomy and low anterior resection were performed in 6, 5 and 4 patients, respectively. All patients underwent minor liver resection. The median number of LM resected was 3 (range 1-8). Five patients underwent additional radiofrequency ablation of LM. Diverting ileostomy was performed in only 1 patient. All patients underwent R0 resection of both CRC and CRLM. No anastomotic leaks were documented. Overall morbidity and 90-day mortality were 20% and 0%, respectively. The 1- and 3-year overall survival of patients was 93% and 66%, respectively. Conclusions: According to our outcomes, the COLICO approach seems a safe and efficient approach for selected patients with resectable synchronous LMs. Selection of patients is of cardinal importance for the performance of SR. Intraoperative parameters such as increased blood loss and prolonged operative time must be taken under account for the performance of the colic anastomosis in order to reduce potential postoperative morbidity and mortality.