Surgical management of synchronous colorectal liver metastases: strategies and clinical practice

The surgical treatment of synchronous colorectal liver metastases (sCRLM) is complex, especially regarding the optimal strategy for resectable cases is controversy. The contro-versies exist in choosing between simultaneous and staged resection, the sequence of bowel‑first or liver‑first in staged resection, and the feasibility of laparoscopic surgery for liver metastases. Based on current situations of surgical treatment at home and abroad and clinical practice experience of the team, the authors compare the efficacy of simultaneous, bowel‑first, and liver‑first resection, and discuss the application of laparoscopic techniques in the treatment of liver metastases. Analysis indicates that the selection of surgical strategy according to liver metastasis burden can significantly improve the surgical safety and survival benefits: for solitary and unilobar multifocal metastases, the three strategies yield similar survival prognoses, yet simultaneous resection may elevate infection risks; for bilobar multifocal metastases, the liver‑first approach shows lower total complications, infection, and mortality rates, and better long‑term survival, making it preferable. In addition, strategy selection should also account for patient tolerance, surgical team skills, estimated operation time and risks. Laparoscopic surgery has advantages as minimal invasiveness, faster recovery, fewer complications, and equivalent long‑term prognosis to open surgery. It should be the first‑choice approach for both simultaneous and staged resection in the treatment of liver metastases.