Currently, there are approximately 103,170 new cases of colon cancer and 40,290 new cases of rectal cancer diagnosed yearly. Approximately 51,690 deaths occur from colorectal cancers annually. Colon and rectal cancer combined are the fourth most common cancer diagnosis and second most common cause of cancer mortality. While the incidence and mortality are decreasing, about half of all patients will develop metastatic disease. Of these patients, 80-90% develops unresectable liver metastases, which include 20-34% who have synchronous hepatic metastases. Recently published, Fahy presented that there are at least 13 different treatment algorithms for synchronous colon cancer with liver metastases [1]. Certainly, this makes it nearly impossible for physicians to rely on any "standard of care" or "standard approach" for these patients. One constant remains, however; treatment recommendations and decisions should be made in the setting of a multidisciplinary team including an experienced hepatobiliary surgeon. This article is not meant to give a comprehensive review of all the possible algorithms, but aims to discuss the timing of surgical resection of the primary cancer and the metastatic disease.
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