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In recent years, the management of synchronous colorectal liver metastasis has changed significantly. Alternative surgical strategies to the classical colorectal‐first approach have been proposed. These include the liver‐first and combined resections approaches. The objectives of this review were to compare the short‐ and long‐term outcomes for all three approaches.

A systematic review of comparative studies was performed. Evaluated endpoints included surgical outcomes (5‐year overall survival, 30‐day mortality, and post‐operative complications). Pair‐wise and network meta‐analysis (NMA) were performed to compare survival outcomes.

Eighteen studies were included in this review, reporting on 3,605 patients. NMA and pair‐wise meta‐analysis of the 5‐year overall survival did not show significant difference between the three surgical approaches: combined versus …