Contemporary Management of Colorectal Liver Metastases

Colorectal liver metastases (CRLM) require treatment selection that integrates technical resectability, oncologic suitability, molecular profile, tumor behavior, and functional liver reserve.Options range from upfront local treatment for readily resectable disease to systemic conversion therapy, parenchymal-sparing surgery, thermal ablation, staged procedures, and, in highly selected patients with permanently unresectable liver-only disease, transplantation.This narrative review critically summarizes diagnostic staging, perioperative chemotherapy, conversion strategies, local treatment, synchronous disease, recurrence, and transplantation.Evidence from pivotal trials illustrates the importance of interpreting results in context as follows: long-term follow-up of European Organisation for Research and Treatment of Cancer (EORTC) 40983 did not show a statistically significant overall survival benefit from peri-operative FOLFOX4; CAIRO5 found regimen-specific differences in progression-free survival and toxicity in initially unresectable liveronly disease; COLLISION supports ablation for selected small metastases but does not establish universal equivalence to resection; and TransMet demonstrated improved survival with transplantation plus chemotherapy in a strictly selected population.These studies address different clinical questions and should not be compared as if they enrolled interchangeable populations.Management should be reassessed by a multidisciplinary team as tumor biology, response, and feasibility of complete local clearance evolve.The review is intended for clinicians involved in colorectal and hepatobiliary oncology and emphasizes clinical applicability, quantitative outcomes, and limitations of pivotal studies rather than a systematic evidence synthesis.