Management of colorectal cancer presenting with synchronous liver metastases

Up to a 20% of patients with colorectal cancer (CRC) present with synchronous hepatic metastasesIn patients who present without intestinal obstruction or perforation, comprehensive whole-body imaging is required to exclude extrahepatic diseaseCurrent evidence indicates a state of equipoise between several different management approaches for the treatment of CRC and synchronous liver metastatic disease, none of which has supportive randomized trial evidenceNeoadjuvant systemic chemotherapy is supported by current guidelines and can result in tumour downsizing, enabling some 'unresectable' liver metastases to be surgically removedSurgery can take the form of the 'classic' approach (colorectal resection, then interval chemotherapy followed by liver resection), synchronous removal of liver and bowel tumours, or a liver-first approachClear superiority has not been demonstrated for any of these surgical interventions for CRC with synchronous liver metastases, although the mode of presentation can determine the approach used