The last 20 years has seen a remarkable expansion in the number of treatments available for patients with colorectal liver metastases. The key to improving outcome however, lies with careful selection of patients and treatments and for this reliance on quality imaging is essential.
To personalise the optimum treatment, all patients with colorectal liver metastases should be discussed within a multidisciplinary team structure. Often, such a group meets with the colorectal cancer multidisciplinary team.

Pre-operative investigation involves high quality contrast CT. More recently FDG-PET and PET CT have been introduced and results in a higher sensitivity and specificity.

In the absence of metastases elsewhere, solitary liver metastases should be resected. Numerous prospective studies have confirmed the benefit of this approach. Actuarial 5 year survivals of up to 40% with a median survival of 54 months has been reported. There is an increasing tendency to consider all patients for resection provided an R0 resection can be achieved irrespective of number or location. However, a resection margin of greater than 1 cm is important.

In situ ablation has become increasingly popular. Indications for radiofrequency ablation include patients with significant morbidity precluding major surgery, and patients who refuse surgery or have tumours in anatomically difficult situations.

Finally, chemotherapy is frequently utilised both for patients with advanced disease involving hepatic and extrahepatic sites and as adjuvant therapy, following liver resection or ablation treatment. In an attempt to increase the resectability rate, neoadjuvant chemotherapy as a down staging modality prior to liver resection is becoming accepted.

In personalising treatment, care must be exercised to avoid potentially unpleasant and dangerous treatment in patients with advanced disease and limited survival. Improving quality of life with appropriate palliative therapy is most important.