A 45-year-old man is found to have synchronous liver metastases from sigmoid colon cancer. He has two bilobar liver metastases (both < 3 cm, no vascular involvement) and a resectable sigmoid primary. His performance status is ECOG 0. The optimal surgical strategy is:

• A Systemic chemotherapy alone; surgery is contraindicated for synchronous metastases
• B Staged approach: colon resection first, then liver resection after 6–8 weeks
• C Liver-first approach: resect metastases first, then colon primary after 6 weeks
• D Simultaneous resection of sigmoid primary and liver metastases in a single operation ✓

Explanation

Simultaneous (synchronous) resection is safe and reduces total anaesthetic exposure when both the primary and liver lesions are technically resectable and the patient has adequate functional liver reserve. Multiple randomised and cohort studies show equivalent morbidity to staged resection for limited bilobar disease in fit patients. The liver-first approach is preferred when the liver disease is at greater risk (e.g., threatened response to chemotherapy) or when a major hepatectomy is needed. Staged colon-first is traditional but not superior for straightforward cases.

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

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Written and medically reviewed by the StethoPrep medical team.