Comprehensive management of synchronous colorectal liver metastases at a high-volume center: a propensity score-matched analysis.

The optimal management of synchronous colorectal liver metastases (CLM) remains debated, particularly regarding the role of centralized care. This study aimed to assess the impact of comprehensive management at a high-volume center on perioperative and long-term outcomes in patients undergoing curative-intent hepatectomy for synchronous CLM. We retrospectively analyzed 613 patients treated from 2010 to 2021 at a tertiary referral center. Patients were categorized as exclusively internally managed (n = 273) or partially externally managed (n = 340). Propensity score matching (PSM) was performed to minimize bias. Exclusively internally managed patients were characterized by a greater rate of rectal cancer and a higher liver tumor burden. Overall, major morbidity was 11.0% and 90-day mortality was 0.6%, with no significant difference between groups. Median overall survival (OS) was 68 months. Independent predictors of worse OS included rectal cancer, advanced T-stage, nodal positivity, > 6 chemotherapy cycles, major hepatectomy, and R1 margins. After PSM (n = 428), exclusively internally managed patients showed improved 5-year OS (54.5% vs. 44.6%, p = 0.054). Comprehensive multidisciplinary management at a high-volume center may improve long-term outcomes in patients with synchronous CLM, particularly those with more advanced disease. Timely referral and consistent multidisciplinary tumor board evaluation are essential to optimize outcomes and guide personalized treatment strategies.