A 68-year-old man is discovered to have a synchronous liver metastasis (solitary, 3 cm) from a sigmoid colon adenocarcinoma during staging CT. Both lesions are resectable. The preferred surgical strategy is:

• A Always stage the resections: colon first, then liver 3 months later after chemotherapy
• B Liver resection first (reverse strategy) is mandatory to prevent tumour progression
• C Simultaneous resection of the colon primary and liver metastasis in a single operation when technically feasible and the patient is fit ✓
• D Liver metastasis should be treated with radiofrequency ablation only, preserving the liver parenchyma

Explanation

Current evidence supports simultaneous (synchronous) resection of the colorectal primary and liver metastasis in fit patients when both lesions are technically resectable and the procedure does not constitute an excessively high-risk combined operation. Simultaneous resection reduces total hospital stay, total anaesthetic exposure, and time to adjuvant chemotherapy without increasing mortality or morbidity compared to staged resection in specialised centres. The 'liver first' approach is reserved for cases where the primary colon tumour is asymptomatic but the liver disease is more immediately threatening. RFA alone is not an equivalent oncological substitute for resectable hepatic metastases.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.