Recently, there has been a change in the strategy of how synchronous @entity99 are attributed to the development of more valuable protocols of chemotherapy and radiotherapy for neoadjuvant treatment of @entity14 and their hepatic metastases. There is a consensus that @entity1 with synchronous @entity99 have lower survival than those with metachronous @entity99 . Currently, controversy remains concerning the best approach is sequence in a @entity1 with @entity14 and synchronous hepatic metastases resection. To obtain a better @entity1 selection, the authors have suggested the initial realization of systemic chemotherapy in the circumstance of @entity1 with @entity14 stage IV, since these @entity1 have a @entity262 . The rationale behind this liver-first strategy is initially the control of synchronous hepatic metastases of @entity14 , which can optimize a potentially curative hepatic resection and longstanding survival. The liver-first strategy procedure is indicated for @entity1 with @entity99 who require downstaging therapy to make a curative liver resection possible. Thus, the liver-first strategy is considered an option in cases of @entity189 in the early stage and with limited or advanced synchronous @entity99 or in case of @entity1 with asymptomatic @entity14 , but with extensive liver metastases. @entity1 undergoing systemic chemotherapy and with progression of @entity5 should not undergo hepatic resection, because it does not change the prognosis and may even make it worse. To date, there have been no randomized controlled trials on surgical approach of @entity99 , despite the relatively high number of available manuscripts on this subject. All of these published studies are observational, usually retrospective, and often non-comparative. The @entity1 selection criteria for the liver-first strategy should be individualized, and the approach of these @entity1 should be performed by a multidisciplinary team so its benefits will be fully realized.

Liver-first approach of XXXX with synchronous hepatic metastases: A reverse strategy.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity5 :: ('MESH:D009369', 'Disease') :: ['neoplastic disease'] @entity262 :: ('MESH:D034721', 'Disease') :: ['systemic disease'] @entity189 :: ('MESH:D002277', 'Disease') :: ['rectal carcinoma'] @entity14 :: ('MESH:D015179', 'Disease') :: ['colorectal neoplasms', 'colorectal carcinoma', 'colorectal tumor', 'colorectal cancer'] @entity99 :: ('MESH:D056486', 'Disease') :: ['colorectal synchronous hepatic metastases', 'colorectal hepatic metastases']
@entity14 :: (MESH:D015179,Disease) :: ['colorectal cancer']
