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Comprehensive Review and Meta-Analysis on the Resection Order for Synchronous Colorectal Liver Metastases: Primary Surgery Compared to Liver First Approach
To conduct a systematic review and meta-analysis comparing outcomes between primary versus liver-first resection strategies for synchronous colorectal liver metastases (CRLM).
Approach:
Literature Search: A comprehensive literature review was performed in PubMed, Cochrane Central trials register, and Google Scholar databases until May 1st, 2025, using specific medical subject headings. No language restriction was applied.
Key Findings:
Approximately 20% of colorectal cancer patients present with synchronous liver metastases.
No significant difference in outcomes has been established between primary first, liver first, and simultaneous resection strategies.
The METASYNC randomized controlled trial suggested a trend toward improved overall survival and disease-free survival for simultaneous resection.
Interpretation:
The evidence comparing liver-first versus primary-first approaches is limited, primarily consisting of retrospective studies and lacking robust randomized controlled trials.
Limitations:
Challenges in patient selection and follow-up in studies evaluating staged resections.
Most studies are retrospective observational studies with potential biases.
Conclusion:
The study aims to clarify the outcomes of different surgical strategies for CRLM, focusing on morbidity, mortality, and survival rates.
U.S. News & World Report has recognized Dana-Farber/Boston Children’s Cancer and Blood Disorders Center as the #1 pediatric cancer program in the nation in its 2026-2027 Best Children’s Hospitals report.
