Up to half of the patients with metastatic colorectal cancer present with liver metastases that have been associated with significant morbidity and may even lead to death. The optimal management remains challenging, especially in terms of selecting the best therapeutic approach that may include surgery, minimally invasive techniques, chemotherapy, targeted therapy, and immunotherapy. Herein, we aim to review and discuss all these modalities and provide guidance for the clinical practice. Recent studies have shown an increase in conversion rates from marginally resectable to resectable colorectal liver metastases, due to the advances in neoadjuvant treatment. Novel applications of interventional radiology, such as hepatic artery infusion and transarterial chemoembolization, are combined with systemic chemotherapy and targeted agents in order to decrease the tumor volume and diameter, which in turn allows for safer and more efficacious surgical management or ablation. For patients with unresectable metastatic disease to the liver, systemic treatment is indicated. The molecular profile of the tumor should inform tailored treatment decisions and guide the administration of the available therapeutic regimens including targeted therapies, chemotherapy and immunotherapy. Current management of colorectal liver metastases necessitates a multidisciplinary team of experts in order to set the therapeutic goals and determine the treatment approach on an individualized basis. Prospective clinical trials are needed to establish the optimal succession of therapies, especially in patients with rapidly progressing disease.