Abstract Introduction Almost 25% of colorectal cancer (CRC) patients have synchronous colorectal liver metastasis (SCLM) coinciding with the disease diagnosis. Liver-first approach for the treatment of SCLM involves neoadjuvant chemotherapy, subsequent liver resection, and then primary tumor resection. This strategy is adopted as the prognosis of the disease depends mainly on the metastases, not the primary tumor. This study aims to evaluate the feasibility of the liver-first approach and clinical prognosis in managing SCLM. Materials and Methods This retrospective study included 25 patients with SCLM from July 2015 to July 2020. All patients were subjected to a liver-first approach with an "intention-to-treat" approach. Follow-up was planned for at least 3 years. Data were collected from the hospital records and included survival rates and univariate analyses of the prognostic factors, such as gender, age, and number of chemotherapy cycles to evaluate their effect on the survival probability. Results Nineteen patients completed the treatment paradigm. Long-term outcomes reported a median overall survival (OS) of 32 months. One-year and 3-year survival probabilities were 89.5% and 42.1%, respectively. The median disease-free survival was 13 months. The number of metastatic lesions, unilobar versus bilobar disease, and the frequency of administered chemotherapy cycles significantly affected survival (p < 0.05). Seven patients (36.84%) remained disease free (no recurrence) while 2 patients (10.53%) survived with recurrence. The overall mortality included 10 deaths (52.63%) due to recurrence. Conclusion Synchronous colorectal liver metastasis treated with the liver-first approach achieved a notable overall advantage. However, the recurrence rate remained relatively high. CRC (CRC (SCLM diagnosis Liverfirst Liver first resection metastases liverfirst 201 2020 intentiontotreat intention treat "intention-to-treat Followup Follow up years factors gender age probability paradigm Longterm Long term OS (OS months Oneyear One year 3year 895 89 5 89.5 421 42 1 42.1% respectively diseasefree lesions p 0.05. 005 0.05 . 0 05 0.05) 36.84% 3684 36 84 (36.84% no 10.53% 1053 53 (10.53% 52.63% 5263 52 63 (52.63% advantage However high 20 202 8 89. 4 42.1 00 0.0 36.84 368 (36.84 10.53 105 (10.53 52.63 526 6 (52.63 42. 0. 36.8 (36.8 10.5 (10.5 52.6 (52.6 36. (36. 10. (10. 52. (52. (36 (10 (52 (3 (1 (5 (