Simultaneous resection of rectal and liver metastases is safe and linked to longer survival in high-risk patients.

• 92 patients showed no deaths; complications were seen in 15% with major issues like drainage (9%) and anastomotic dehiscence (3%).
• Median overall survival was 70 months, with recurrence-free survival at 10 months.

Choose simultaneous resection judiciously; it can enhance patient outcomes when appropriately selected.

• Positive hepatic margins lowered overall survival, while higher clinical risk scores and tumor burden reduced recurrence-free survival rates.