Colorectal cancer is the fourth most common cancer in the UK and contributes to over 700,000 deaths worldwide per year. When first diagnosed, colorectal cancer has already metastasized in 20% of patients to the liver and beyond (termed ‘synchronous’). In these patients, 5-year survival is less than 7%. For patients with metastases limited to the liver, surgery and systemic chemotherapy can improve 5-year survival up to 25-40%. Conventional surgery removes the colorectal primary first, followed by chemotherapy, and then resection of the liver metastases. Advances in critical care and innovations such as colonic stenting have allowed liver-first and simultaneous bowel and liver surgery to become viable options. Currently, there is no conclusive evidence to show which approach is optimum, and therefore no standardised clinical pathway. This thesis, Colorectal cancer with Synchronous liver-limited hepatic Metastasis: an Inception Cohort and Qualitative Study (CoSMIC) provides a first mixed method approach to study the process of care and outcomes following synchronous or staged surgery in patients with colorectal cancer and synchronous liver-limited metastases. CoSMIC found no significant difference in survival according to treatment pathway, with the exception of the No Surgery group who had a poorer survival consistent with more advanced disease and comorbidity. In line with previous findings, the lack of survival difference for the sequence of surgery suggests equipoise. However, the CoSMIC qualitative study found a strong clinical preference from both clinicians and patients for the choice of treatment pathway. CoSMIC has demonstrated the potential of an inception cohort approach to study patients with colorectal cancer with synchronous liver-limited metastases. Optimal management of synchronous disease is a complex research question, linking surgical and chemotherapeutic pathways. Given this interplay of aspects of treatment and presentation of disease, further epidemiological research may be the most appropriate research design to further enhance understanding.