Liver is the most common target organ for hematogenous metastasis. When malignant tumors grow to a certain extent, tumor cells will invade blood vessels and disseminate systemically with blood. After tumor cells enter and stay in the liver, they will stimulate the liver to secrete cytokines, leading to inflammation and changes in immune microenvironment, which further induce neovascularization and promote the growth of liver metastases. Tumors that are more prone to liver metastasis include colorectal cancer, lung cancer, breast cancer, pancreatic cancer, gastric cancer, gallbladder cancer, extrahepatic bile duct cancer, kidney cancer, cervical cancer, ovarian cancer, prostate cancer, etc. Since blood from gastrointestinal tract, pancreas and spleen flows back into the portal system of liver, more than half of liver metastases originate from gastrointestinal tract tumors, and the proportion of liver metastases from colorectal cancer is as high as 50%. Once liver metastasis occurs, does it mean that the disease is advanced and there is no treatment? It is true that patients with distant metastases are relatively advanced, but with the development of medical science, not all patients with advanced disease are untreatable. However, with the development of medical science, not all patients with advanced disease are without treatment. Comprehensive treatment based on surgery has brought hope to many patients with advanced cancer. Generally speaking, patients with metastatic liver cancer do not have obvious clinical symptoms. Most patients’ symptoms are still mainly the manifestations of the primary tumor, such as change in stool characteristics in colorectal cancer, abdominal pain and black stool in gastric cancer, and progressive worsening jaundice in pancreatic cancer. When liver metastases are large, patients may experience distention and pain in the liver area, weakness, weight loss, and even ascites and jaundice. A large proportion of patients are post-operative patients with primary tumors, and clinicians will ask patients to have regular follow-up examinations. In addition to observing whether there is any recurrence at the site of primary tumor resection, it is quite important to regularly check for liver metastases. The routine review includes blood sampling for tumor indicators (AFP, CEA, CA199, CA125, etc.) and impact examinations. Generally, liver ultrasonography can detect tumors above 25px. For suspicious lesions suspected by ultrasonography, further enhancement MRI is recommended for clarification. For patients with confirmed liver metastases, we advocate an individualized treatment model with multidisciplinary participation and collaboration. In other words, the patient’s primary and metastatic foci, the patient’s tolerance, and the sensitivity of the tumor to radiotherapy are evaluated comprehensively, and different treatments are given to different patients. In the past, patients with distant metastases were considered to have lost their surgical indications, but with the rapid development of comprehensive treatments such as chemotherapy, radiotherapy, biological therapy and targeted therapy, as well as the great progress of surgical techniques in recent years, surgical resection of metastases followed by a series of adjuvant treatments have significantly prolonged patients’ survival time after surgery. Take patients with liver metastases from colorectal cancer as an example, a large proportion of patients with simultaneous liver metastases (metastases in the liver found at the same time as the primary tumor) can be removed from both the primary intestine and liver metastases in a single operation, especially the widespread application of minimally invasive laparoscopic surgery makes simultaneous removal of both organs no longer a contraindication to surgery, and the reduced trauma makes patients’ tolerance significantly increased. Postoperatively, supplemented with chemotherapy and targeted therapy, a large proportion of patients are able to achieve long-term survival. For patients with heterotopic liver metastases (liver metastases found after primary tumor resection), surgical resection remains the most effective treatment for liver metastases from colorectal cancer, which of course still needs to be supplemented with chemotherapy after surgery. For some patients with liver metastases that cannot be resected at stage I, the tumor may shrink after neoadjuvant chemotherapy and the patient may regain the chance of surgical resection. In addition, the maturity of local treatment such as radiofrequency ablation and microwave ablation allows some patients to undergo surgical resection combined with local treatment, in which most of the tumors are removed surgically, while some small tumors in deeper locations can be eliminated through local treatment, further improving the safety and efficacy of surgery. Of course, there is still a 60% chance of recurrence after resection of liver metastases, and about 1/3 of the metastases still appear in the liver. As long as the conditions for surgery are met, another surgical resection can still significantly extend the survival time of patients. The development of medical science has made metastatic liver cancer no longer an incurable disease, and active surgical treatment supplemented with radiotherapy and other comprehensive treatments have given patients with metastatic liver cancer a new lease of life.