Background In recent years, the management of synchronous colorectal liver metastasis has changed significantly. Alternative surgical strategies to the classical colorectal‐first approach have been proposed. These include the liver‐first and combined resections approaches. The objectives of this review were to compare the short‐ and long‐term outcomes for all three approaches. Methods A systematic review of comparative studies was performed. Evaluated endpoints included surgical outcomes (5‐year overall survival, 30‐day mortality, and post‐operative complications). Pair‐wise and network meta‐analysis (NMA) were performed to compare survival outcomes. Results Eighteen studies were included in this review, reporting on 3,605 patients. NMA and pair‐wise meta‐analysis of the 5‐year overall survival did not show significant difference between the three surgical approaches: combined versus colorectal‐first, mean odds ratio (OR) 1.02 (95% CI 0.8–1.28, P = 0.93); liver‐first versus colorectal‐first, mean OR 0.81 (95% CI 0.53–1.26, P = 0.37); liver‐first versus combined, mean OR 0.80 (95% CI 0.52–1.24, P = 0.41). In addition NMA of the 30‐day mortality among the three approaches also did not observe statistical difference. Analysis of variance showed that mean post‐operative complications of all approaches were comparable (P = 0.51). Conclusion There are considerable differences in the peri‐operative management of synchronous CLM patients. This meta‐analysis demonstrated no clear statistical surgical outcome or survival advantage towards any of the three approaches. J. Surg. Oncol. 2015 111:341–351. © 2014 Wiley Periodicals, Inc.