Different Surgical Strategies in Colorectal Cancer Patients With Synchronous Liver Metastasis: A Meta-Analysis

This systematic review aimed to evaluate and compare the short- and long-term outcomes of different treatment strategies for patients with colorectal adenocarcinoma presenting with synchronous liver metastases. A comprehensive literature search was conducted in PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Ovid, and ScienceDirect to identify relevant studies assessing surgical sequencing strategies in patients without extrahepatic disease. Data were extracted and analyzed using Review Manager software. Pooled dichotomous outcomes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs), while continuous outcomes were reported as mean differences (MDs) with corresponding 95% CIs. Three treatment strategies were evaluated: the classical "colon-first" approach, the "liver-first" approach, and the simultaneous resection approach. Overall survival (OS) at 1, 3, and 5 years was the primary outcome. The pooled results demonstrated no statistically significant differences in survival outcomes among the three strategies. When compared with the colon-first approach, simultaneous resection showed comparable 1-year (90.1% vs 87.9%), 3-year (66.5% vs 56.2%), and 5-year survival rates (48% vs 40.7%). Similarly, comparisons between colon-first and liver-first approaches revealed no significant differences in 1-, 3-, or 5-year overall survival. These findings indicate that no single surgical sequencing strategy confers a clear survival advantage. Accordingly, treatment decisions should be individualized, taking into account patient characteristics, hepatic tumor burden, primary tumor features, and institutional expertise within a multidisciplinary framework. Further high-quality randomized controlled trials are needed to better define optimal management strategies for this complex and heterogeneous patient population.