# Liver-first approach

Liver-first approach

The traditional surgical strategy for resectable synchronous colorectal liver metastases (CRLMs) is colonic resection followed by chemotherapy and a delayed liver resection. This may allow progression of  the liver disease and render the CRLM unresectable, which is a particular concern in patients who develop postoperative complications following their colon resection that delay or prevent chemotherapy . The liver-first approach or reverse strategy is a downstaging regimen consist - ing of  systemic chemotherapy , chemoradiotherapy and/or biological agents, followed by resection of  the CRLM prior to removal of the colonic primary . T he approach is valuable in the subset of  patients in whom failure to respond to systemic treatment potentially renders CRLMs non-resectable.