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There remain no consensus guidelines on the optimum surgical strategy for the management of synchronous colorectal liver metastases in spite of a number of published reviews and meta-analyses (1,2). In their paper, Howard et al. describe the ‘real world’ referral pattes and resection pathways of Canadian surgeons for this challenging patient cohort (3). This is a timely and interesting area for study. Data was generated from an online survey sent out to all surgeons in Canada. Responses were received from 58 surgeons but 6 responses were inadequate for analysis leaving 52 surgeon responses included for analysis. The study does not indicate the total number of surgeons who were invited to participate and so the proportional response rate is unknown. Like all survey based-studies, the small number of respondents included does raise the question of inherent selection bias which cannot be discounted. In addition, almost all included surgeons had access to hepatobiliary services, with over half reporting access to hepatobiliary surgeons within their own institutions, such availability would undoubtedly affect decision making in this setting. Providing information around the nature and scope of general surgical and surgical oncology training in Canada would have been useful in understanding the likely experience of surgeons. Nonetheless this paper raises some interesting points in the management of patients with synchronous colorectal liver metastases.