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Objective: To analyze long-term outcomes and related risk factors in patients undergoing simultaneous resection of synchronous colorectal liver metastasis., Methods: Clinicopathological, short- and long-term outcome data of 154 consecutive synchronous colorectal liver metastasis patients who underwent simultaneous resection between July 2003 and July 2013 were collected and analyzed with Cox multivariate methods retrospectively., Results: No perioperative death was found. A total of 46 patients (29.9%) had complications, which were all successfully treated medically or by percutaneous drainage. The 5-year overall survival rate was 46%, and the 5-year disease-free survival rate was 35%. Four factors were found to be independent predictors of poor overall survival by multivariate analysis: positive lymph node status (P=0.000), number of metastasis focus (≥4) (P=0.017), bilobar liver metastasis distribution (P=0.004) and non-R0 resection of liver metastasis (P=0.001). Three factors were found to be independent predictors of poor disease-free survival by multivariate analysis: positive lymph node status (P=0.031), bilobar liver metastasis distribution (P=0.001) and extrahepatic metastases (P=0.020)., Conclusions: Simultaneous resection of synchronous colorectal liver metastasis is safe and its short- and long-term outcomes are quite good. Positive lymph node status, number of metastasis focus (≥4), bilobar liver metastasis distribution, non-R0 resection of liver metastasis and extrahepatic metastasis are risk factors of poor long-term prognosis.