The past two decades have witnessed evolution in the treatment of colorectal cancer liver metastases that exemplifies the benefits of multimodality and multidisciplinary treatment of cancer. A decrease in the patients’ mortality rates from 10% to approximately 1% in experienced centers is seen.

Patients’ median survival with untreated colorectal liver metastases is 6 to 12 months, and long-term survival is rare. The synergistic combination of effective systemic chemotherapy and safe surgical resection allows patients with resectable colorectal liver metastases to achieve 5-year survival of 40% to 60% suggested by Dhir and Sasson.

The prime contraindication to resection of colorectal liver metastases is the inability to leave sufficient functional liver behind. Treatment of colorectal liver metastases to disappearance may complicate identification of the 83% lesions that might contain viable tumor for subsequent resection. This is only curative modality available to patients with colorectal liver metastases.

An experienced surgical oncologist should be involved early in the care of the patient with colorectal liver metastases. The sequence of resection of the primary tumor, resection of liver metastases, and systemic treatment have become significantly more variable and complex in recent years.

There needs to be a fundamental shift in our conception of the role surgeons may play in treating metastatic cancer. We need to integrate the medical and surgical advances in treating metastatic colorectal cancer by establishing a standard of care that insists on the true multidisciplinary evaluation of every patient with colorectal liver metastases.