The role of synchronous procedures in the treatment of colorectal liver metastases.

Twenty-five percent of colorectal cancer patients present with synchronous disease in the bowel and liver. Traditionally, the primary cancer was resected and the patient re-staged some 3-4 months later. In the interim, the majority of oncology centres offered these patients chemotherapy. At re-staging, if conditions remained favourable, hepatic resection was considered. This treatment protocol was supported by the literature published in the 1990s. However, there have been many advances in aggressive multimodality care of patients with metastatic colorectal cancer and there are increasing reports of the benefits of synchronous resection for this population of patients.