Surgical resection of hepatic metastatic disease from colorectal cancer offers the best survival advantage when compared to other treatment modalities as survival from unresected disease is rare. Even after adequate surgical excision of colorectal cancer, 20–40 % of patients will develop recurrent disease to the liver. This chapter discusses the management of patients with recurrent colorectal metastases to the liver after initial resection and offers strategies to optimize and guide their treatment with a multimodality approach.