Surgical strategies to synchronous colorectal liver metastases.

Synchronous colorectal liver metastases include a wide variety of clinical presentation depending on the location and the extent of the primary tumor, the extent of metastatic disease in the liver, and the presence of extrahepatic disease. Only a minority of patients with synchronous colorectal liver metastases and an intact primary tumor can be candidates for a curative treatment approach. In the past two decades, considerable progress with both antitumor agents and surgical strategies has contributed to increase the number of patients that can achieve complete resection of primary tumor and liver metastases. Optimal treatment of colorectal resectable liver metastases includes preoperative chemotherapy that can be administered after resection of the primary tumor and before resection of liver metastases in a 'classical' fashion, before combined resection of the primary tumor and liver metastases, and before liver resection of liver metastases followed by resection of the primary tumor in the reverse strategy. With regard to the large variety of clinical presentations in patients with synchronous colorectal liver metastases, none of these treatment strategies can be recommended in all patients. The complexity and the multiplicity of available treatment options underline the need for a multidisciplinary approach to this disease.