In summary, the natural history of patients presenting with synchronous liver metastases has been well documented. However, the epidemiology and natural history of patients presenting with metachronous disease is scant. It is clear, therefore, that the accurate detection of occult liver metastases at the time of presentation underpins further improvements in the selection of appropriate treatment for patients presenting with colorectal cancer. This will facilitate early referral for investigation and treatment of their liver metastases.