Among patients with colorectal cancer and synchronous liver metastases, the subgroup with a primary cancer in the rectum is especially challenging. Compared with colon cancer, most patients with stage IV rectal cancer will have locally advanced primary tumors at increased risk for obstructive and/or post-operative complications resulting in delays in systemic therapy. In this episode from the HPB team at Behind the Knife, listen in on the discussion about treatment sequencing for synchronous liver metastasis from rectal cancer.