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Background: Colorectal cancer (CRC) is ranked as the third most common cancer worldwide.One of the leading causes of death in CRC patients is due to its metastasis. The liver is the most common site of metastasis. The best treatment to achieve long-term survival and cure patients with CRC liver metastasis is surgery, whether it’s sequential, delayed, or simultaneous resection.This case study aims to evaluate the simultaneous resection on the patient with synchronous colorectal liver metastasis.Case Presentation: From January-June 2020, in Prof. Dr. R. D. Kandou General Hospital, Manado, 2 patients were treated with simultaneous resection for CRC with resectable synchronous liver metastasis. Blood loss, bile leak, ascites, and post hepatectomy liver failure (PHLF) were observed as outcome parameters.Conclusion: Simultaneous resection is safe and exhibits advantages in the long-time survival of patients. However, the incidence of complications and mortality are higher in simultaneous resection than in staged resection.

Background: The role of liver surgery is increasing for primary and secondary liver tumors. One of the most feared complications of liver surgery is Post-Hepatectomy Liver Failure (PHLF). The authors would like to present their experience in a year for liver surgery with morbidity and mortality, including PHLF as evaluation parameters.Methods: This is a prospective study from July 2019-2020 in a single-center, in which patients with pre-existing liver pathology were assigned to receive liver resection. Types and duration of liver resection, duration of Pringle maneuver, and blood loss were measured. PHLF was evaluated using the ISGLS classification, and morbidity was evaluated using Clavien-Dindo and FABIB classification. The energy device used varies from the harmonic scalpel, ligature, and Thulium-doped fiber laser (TDFL). Data were processed descriptively with IBM SPSS 25 (SPSS Inc., Chicago, USA). Data are presented in descriptive frequency tables as medians and means.Results: A total of 17 procedures were performed, including minor hepatectomies (58.82 %) and major hepatectomies (41.18%). The mean duration of operation 5.3 hours, the duration of parenchymal transection 91.5 minutes, and the estimated blood loss 1638.2 cc. Vascular occlusion method using Pringle maneuver with mean duration of 31.67 minutes. PHLF incidence found were grade B (5.88 %) and grade C (11.7%), while morbidities by Clavien-Dindo mostly are grade 2 (38.2%) and FABIB classification mostly are Bleeding (45%). The mean postoperative ICU is 3.06days, and the mortality rate is as high as 23.52%.Conclusion: Liver resection in our center is quite fair judging from the low incidence of PHLF, although the mortality rate is at 23.52%. Due to that, surgical technique and teamwork between units involved need to be improved even further.